Provider Demographics
NPI:1073829339
Name:SALAS-GONZALEZ, LAURA IVETTE (MA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:IVETTE
Last Name:SALAS-GONZALEZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 2 BOX 11851
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-8347
Mailing Address - Country:US
Mailing Address - Phone:787-585-5521
Mailing Address - Fax:
Practice Address - Street 1:HC 2 BOX 11851
Practice Address - Street 2:
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676-8347
Practice Address - Country:US
Practice Address - Phone:787-585-5521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2503103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool