Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | TAC-III-05-20-2620 | PR |
Y | 225C00000X | Rehabilitation Counselor | 1671 | PR |
NPI | 1245837327 |
---|---|
Provider Name | Mr. Christopher Jose Gotay Serrano |
First Address | Ponce, PR 00716 |
Second Address | Ponce, PR 00716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2020 |
Last Update Date | 20/01/2022 |