MEDICARE: NIDZALIZ GONZALEZ RAMOS

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	103TC1900X	Counseling Psychologist	8156	PR

General Provider Information

NPI Number	:	1306654157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIDZALIZ GONZALEZ RAMOS

Provider Business Mailing Address
First Line	:	PR6 VIA 19
Second Line	:
City	:	CAROLINA
State	:	PR
Zip	:	00983-4705
Country	:	US
Telephone Number	:	787-587-7590
Fax Number	:

Provider Business Practice Location Address
First Line	:	CONDOMINIO EL CENTRO 1 AVE. MUNOZ RIVERA #500
Second Line	:	OFICINA 242
City	:	SAN JUAN
State	:	PR
Zip	:	00918
Country	:	US
Telephone Number	:	787-587-7590
Fax Number	:

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

Provider Enumeration Date	:	12/26/2024
Last Update Date	:	07/01/2026

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