1780665232 NPI number — DR. LAURA ALICIA GONZALEZ PSY.D.

Table of content: DR. LAURA ALICIA GONZALEZ PSY.D. (NPI 1780665232)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780665232 NPI number — DR. LAURA ALICIA GONZALEZ PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GONZALEZ
Provider First Name:
LAURA
Provider Middle Name:
ALICIA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BORGOS
Provider Other First Name:
LAURA
Provider Other Middle Name:
GONZALEZ
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PSY.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1780665232
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4837 AVE ISLA VERDE
Provider Second Line Business Mailing Address:
COND GIRASOL APT # 508
Provider Business Mailing Address City Name:
CAROLINA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00979-5418
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-594-5686
Provider Business Mailing Address Fax Number:
787-982-2554

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
107 ORTEGON AVE, SUITE 206
Provider Second Line Business Practice Location Address:
CAPARRA GALLERY BLDG
Provider Business Practice Location Address City Name:
GUAYNABO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-594-5686
Provider Business Practice Location Address Fax Number:
787-982-2554
Provider Enumeration Date:
11/10/2005

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: 103TC0700X , with the licence number:  70 , 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)