Healthcare Provider Details

I. General information

NPI: 1467673806
Provider Name (Legal Business Name): JOSE GUSTAVO JAVIER LAGUER PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 02/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1665 PASEO VILLA FLORES; URB VILLA FLORES
PONCE PUERTO RICO
00716
UM

IV. Provider business mailing address

2304 CALLE LOMAS, URB. VALLE ALTO
PONCE PUERTORICO
00730
UM

V. Phone/Fax

Practice location:
  • Phone: 17876081270
  • Fax:
Mailing address:
  • Phone: 787-367-4623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2756
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: