MEDICARE: MARIANGELY GOMEZ AGOSTO

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	7801	PR

General Provider Information

NPI Number	:	1578280988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIANGELY GOMEZ AGOSTO

Provider Business Mailing Address
First Line	:	URB. SANTA CRUZ A17 CALLE 4
Second Line	:
City	:	BAYAMON
State	:	PR
Zip	:	00961-6917
Country	:	US
Telephone Number	:	787-909-5359
Fax Number	:

Provider Business Practice Location Address
First Line	:	URB. SANTA CRUZ A17 CALLE 4
Second Line	:
City	:	BAYAMON
State	:	PR
Zip	:	00961-6917
Country	:	US
Telephone Number	:	787-909-5359
Fax Number	:

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

Provider Enumeration Date	:	10/26/2022
Last Update Date	:	02/23/2026

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