MEDICARE: MR. JULIO ANGEL GONZALEZ SR. MA

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	7164	PR

General Provider Information

NPI Number	:	1407637986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JULIO ANGEL GONZALEZ SR. MA

Provider Business Mailing Address
First Line	:	HC 3 BOX 12068
Second Line	:
City	:	CAROLINA
State	:	PR
Zip	:	00987-9617
Country	:	US
Telephone Number	:	787-241-5309
Fax Number	:

Provider Business Practice Location Address
First Line	:	CARR. 185 KM 12.6 BO. CEDROS
Second Line	:
City	:	CAROLINA
State	:	PR
Zip	:	00987-0098
Country	:	US
Telephone Number	:	787-241-5309
Fax Number	:

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

Provider Enumeration Date	:	10/10/2023
Last Update Date	:	10/10/2023

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Directions to “ MR. JULIO ANGEL GONZALEZ SR. MA” Practice Location

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