MEDICARE: DR. DANEIDA M PEREZ GONZALEZ PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	4165	PR

General Provider Information

NPI Number	:	1235487026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANEIDA M PEREZ GONZALEZ PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 8410
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00732-8410
Country	:	US
Telephone Number	:	787-662-7623
Fax Number	:

Provider Business Practice Location Address
First Line	:	COND LAS AMERICAS
Second Line	:	2351
City	:	PONCE
State	:	PR
Zip	:	00717-0636
Country	:	US
Telephone Number	:	939-285-3344
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/27/2012
Last Update Date	:	03/13/2019

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