Healthcare Provider Details

I. General information

NPI: 1518665900
Provider Name (Legal Business Name): MAYRA E GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAYRA ENID GONZALEZ MSW

II. Dates (important events)

Enumeration Date: 02/16/2023
Last Update Date: 02/16/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

APARTADO POSTAL 366528
SAN JUAN PR
00936-6528
US

IV. Provider business mailing address

APARTADO POSTAL 366528
SAN JUAN PR
00936-6528
US

V. Phone/Fax

Practice location:
  • Phone: 787-754-8500
  • Fax: 787-999-0838
Mailing address:
  • Phone: 787-754-8500
  • Fax: 787-999-0838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4436
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: