Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 4122 | PR |
N | 1041C0700X | Clinical Social Worker | 8884 | PR |
NPI | 1063614097 |
---|---|
Provider Name | Dr. Jose Antonio Gonzalez |
First Address | Caguas, PR 00725 |
Second Address | Aguas Buenas, PR 00703 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2007 |
Last Update Date | 27/07/2012 |