MEDICARE: OLGA IRIS GONZALEZ VIRUET PSYD

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	7954	PR

General Provider Information

NPI Number	:	1710728225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLGA IRIS GONZALEZ VIRUET PSYD

Provider Business Mailing Address
First Line	:	235 LA REPRESA
Second Line	:
City	:	ARECIBO
State	:	PR
Zip	:	00612-6913
Country	:	US
Telephone Number	:	787-454-7955
Fax Number	:

Provider Business Practice Location Address
First Line	:	CARR 2 KM 68.2 INTERIOR EDIFICIO F. SOTO
Second Line	:	SEGUNDO PISO SUITE 201
City	:	ARECIBO
State	:	PR
Zip	:	00612-4521
Country	:	US
Telephone Number	:	787-454-7955
Fax Number	:

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

Provider Enumeration Date	:	06/06/2024
Last Update Date	:	06/16/2026

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