MEDICARE: DIANELSIE GUZMAN GONZALEZ PSY.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	1954	PR

General Provider Information

NPI Number	:	1548452006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANELSIE GUZMAN GONZALEZ PSY.D

Provider Business Mailing Address
First Line	:	FLORAL PARK
Second Line	:	432 LLORENS TORES
City	:	SAN JUAN
State	:	PR
Zip	:	00912-3955
Country	:	US
Telephone Number	:	939-630-4640
Fax Number	:

Provider Business Practice Location Address
First Line	:	429 CALLE LOS PINOS APT 1102
Second Line	:	CONDOMINIO FLORAL PLAZA
City	:	SAN JUAN
State	:	PR
Zip	:	00917-3409
Country	:	US
Telephone Number	:	939-630-4640
Fax Number	:

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

Provider Enumeration Date	:	08/17/2007
Last Update Date	:	03/21/2017

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