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General NPI Number Information
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NPI Number | 1235404070
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Entity Type | Individual
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Provider Name | JOSE ANGEL GANDIA PH.D.
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Gender | Male
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Dates
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Enumeration Date | 03/13/2012
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Last Update Date | 03/13/2012
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Provider Practice Location Address
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Address Line | 9140 CALLE MARINA SUITE 502
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City | PONCE
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State | PR
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Zip | 00717
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Country | US
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Telephone | 787-485-6348
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Fax |
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Provider Business Mailing Address
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Address Line | 9140 CALLE MARINA SUITE 502
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City | PONCE
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State | PR
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Zip | 00717
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Country | US
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Telephone | 787-485-6348
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3500
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 3500
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License Number State | PR
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Taxonomy #3
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Taxonomy Code | 103TF0000X
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Taxonomy Name | Family Psychologist
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License Number | 3500
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License Number State | PR
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Taxonomy #4
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number | 3500
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License Number State | PR
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