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General NPI Number Information
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NPI Number | 1447036363
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Entity Type | Individual
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Provider Name | RICARDO GONZALEZ PABON PHD
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Gender | Male
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Dates
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Enumeration Date | 09/06/2023
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | AVE. PONCE DE LEON 452 EDIFICIO DE ASOCIACION DE MAESTROS/ 514
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City | SAN JUAN
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State | PR
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Zip | 00918
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Country | US
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Telephone | 787-608-5355
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Fax |
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Provider Business Mailing Address
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Address Line | ESTANCIAS DEL RIO 26 TALLABOA
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City | AGUAS BUENAS
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State | PR
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Zip | 00703
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Country | US
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Telephone | 787-608-5355
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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 | 006219
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License Number State | PR
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