MEDICARE: MANUELA JOSEFA GONZALEZ PHD

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	103T00000X	Psychologist	914	PR

General Provider Information

NPI Number	:	1306710769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANUELA JOSEFA GONZALEZ PHD

Provider Business Mailing Address
First Line	:	F5 CALLE FRANCIA
Second Line	:
City	:	GUAYNABO
State	:	PR
Zip	:	00966-2015
Country	:	US
Telephone Number	:	787-638-3144
Fax Number	:

Provider Business Practice Location Address
First Line	:	51-59 CALLE MARGINAL
Second Line	:
City	:	BAYAMON
State	:	PR
Zip	:	00959-6837
Country	:	US
Telephone Number	:	787-638-3144
Fax Number	:

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

Provider Enumeration Date	:	09/30/2025
Last Update Date	:	09/30/2025

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