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General NPI Number Information
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NPI Number | 1386131175
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Entity Type | Individual
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Provider Name | JAYLEEN GORRITZ
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Gender | Female
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Dates
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Enumeration Date | 04/17/2018
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Last Update Date | 04/17/2018
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Provider Practice Location Address
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Address Line | CARR 695 KM 2.0 BO HIGUILLAR PLAZA DORAVILLE CARR
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City | DORADO
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State | PR
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Zip | 00646
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Country | US
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Telephone | 787-242-0929
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Fax |
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Provider Business Mailing Address
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Address Line | S21 URB THE CLUSTERS OCEAN BLUE LANE
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City | DORADO
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State | PR
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Zip | 00646
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Country | US
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Telephone | 787-242-0929
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 5935
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License Number State | PR
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