Provider Demographics
NPI:1053302661
Name:DE MIER-GONZALEZ, LOUIS A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:A
Last Name:DE MIER-GONZALEZ
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 CALLE SAN PEDRO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-5315
Mailing Address - Country:US
Mailing Address - Phone:787-408-1701
Mailing Address - Fax:
Practice Address - Street 1:1007 AVE MUNOZ RIVERA
Practice Address - Street 2:STE 510
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925-2723
Practice Address - Country:US
Practice Address - Phone:787-408-1701
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2457103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical