Provider Demographics
NPI:1467183335
Name:ROJAS GAGO, MARANGELIE (MS)
Entity Type:Individual
Prefix:MS
First Name:MARANGELIE
Middle Name:
Last Name:ROJAS GAGO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 18 BOX 780A
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-9923
Mailing Address - Country:US
Mailing Address - Phone:787-644-2184
Mailing Address - Fax:
Practice Address - Street 1:CENTRO TERCERA ONDA AVENIDA PARANA
Practice Address - Street 2:# 22-46
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-510-9032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6898103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty