Provider Demographics
NPI:1043396088
Name:GONZALEZ, SADIA L
Entity Type:Individual
Prefix:DR
First Name:SADIA
Middle Name:L
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 190100
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-0100
Mailing Address - Country:US
Mailing Address - Phone:787-636-7777
Mailing Address - Fax:
Practice Address - Street 1:2 ST B-28 FLAMBOYAN ALTS
Practice Address - Street 2:AVE TNTE RODRIGUEZ
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-0000
Practice Address - Country:US
Practice Address - Phone:787-636-7777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2399103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical