Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 2503 | PR |
NPI | 1073829339 |
---|---|
Provider Name | Laura Ivette Salas-Gonzalez |
First Address | Moca, PR 00676-8347 |
Second Address | Moca, PR 00676-8347 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2010 |
Last Update Date | 25/08/2010 |