Provider Demographics
NPI:1407637986
Name:GONZALEZ, JULIO ANGEL SR (MA)
Entity Type:Individual
Prefix:MR
First Name:JULIO
Middle Name:ANGEL
Last Name:GONZALEZ
Suffix:SR
Gender:M
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 3 BOX 12068
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-9617
Mailing Address - Country:US
Mailing Address - Phone:787-241-5309
Mailing Address - Fax:
Practice Address - Street 1:CARR. 185 KM 12.6 BO. CEDROS
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987-0098
Practice Address - Country:US
Practice Address - Phone:787-241-5309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7164103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist