Provider Demographics
NPI:1255502860
Name:GONZALEZ MARTINEZ, NIXALYS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:NIXALYS
Middle Name:
Last Name:GONZALEZ MARTINEZ
Suffix:
Gender:F
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:PO BOX 260
Mailing Address - Street 2:
Mailing Address - City:HORMIGUEROS
Mailing Address - State:PR
Mailing Address - Zip Code:00660-0260
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:129 CALLE VILLA
Practice Address - Street 2:APT. 41-42
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-4902
Practice Address - Country:US
Practice Address - Phone:787-226-4460
Practice Address - Fax:787-849-3039
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-22
Last Update Date:2008-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2981103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical