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General NPI Number Information
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NPI Number | 1992008817
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Entity Type | Individual
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Provider Name | MYRIAM GONZALEZ PSY. D.
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Gender | Female
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Dates
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Enumeration Date | 12/15/2010
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Last Update Date | 12/15/2010
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Provider Practice Location Address
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Address Line | CONDOMINIO PLAYA DORADA APARTAMENTO 616 B 7043 CARRETERA 187
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City | CAROLINA
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State | PR
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Zip | 00979
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Country | UM
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Telephone | 787-536-1317
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Fax | 787-200-5149
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Provider Business Mailing Address
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Address Line | CONDOMINIO PLAYA DORADA APARTAMENTO 616 B 7043 CARRETERA 187
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City | CAROLINA
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State | PR
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Zip | 00979
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Country | UM
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Telephone | 787-536-1317
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Fax | 787-200-5149
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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 | 678
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License Number State | PR
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