Healthcare Provider Details

I. General information

NPI: 1710231444
Provider Name (Legal Business Name): MARIBELLA GONZALEZ-VIRUET PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2012
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1788 CALLE JULIO AYBAR
SAN JUAN PR
00921-4410
US

IV. Provider business mailing address

3011 ALEJADRINO AVE COND. VIEW POINT APT 504
GUAYNABO PR
00969
US

V. Phone/Fax

Practice location:
  • Phone: 787-638-3520
  • Fax:
Mailing address:
  • Phone: 787-638-3520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2114
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number2114
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: