1639063035 NPI number — CARILLE GONZALEZ GOMEZ THL

Table of content: CARILLE GONZALEZ GOMEZ THL (NPI 1639063035)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639063035 NPI number — CARILLE GONZALEZ GOMEZ THL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GONZALEZ GOMEZ
Provider First Name:
CARILLE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
THL
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639063035
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/09/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
URB RIVERAS DEL BUCANA 2535 CALLE FLORIN
Provider Second Line Business Mailing Address:
TERAPIADELHABLA@YAHOO.COM
Provider Business Mailing Address City Name:
PONCE
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00731-0073
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
939-286-6468
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
URB RIVERAS DEL BUCANA
Provider Second Line Business Practice Location Address:
2535 CALLE FLORIN
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00731-0073
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
939-286-6486
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/09/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2355S0801X , with the licence number:  1070 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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