Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 1261 | PR |
NPI | 1649948118 |
---|---|
Provider Name | Miss Angelica Marie Gonzalez Rodriguez |
First Address | Naguabo, PR 00718-0889 |
Second Address | Naguabo, PR 00718 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2021 |
Last Update Date | 31/08/2021 |