Provider Demographics
NPI:1235487026
Name:PEREZ GONZALEZ, DANEIDA M (PHD)
Entity Type:Individual
Prefix:DR
First Name:DANEIDA
Middle Name:M
Last Name:PEREZ GONZALEZ
Suffix:
Gender:F
Credentials:PHD
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 8410
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-8410
Mailing Address - Country:US
Mailing Address - Phone:787-662-7623
Mailing Address - Fax:
Practice Address - Street 1:COND LAS AMERICAS
Practice Address - Street 2:2351
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-0636
Practice Address - Country:US
Practice Address - Phone:939-285-3344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-27
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4165103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical