Provider Demographics
NPI:1467631143
Name:GONZALEZ, JOSE A (MA, DMIN)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:A
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MA, DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 AVE ITURREGUI
Mailing Address - Street 2:URB. COUNTRY CLUB
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-1723
Mailing Address - Country:US
Mailing Address - Phone:787-287-2958
Mailing Address - Fax:
Practice Address - Street 1:818 AVE ITURREGUI
Practice Address - Street 2:COUNTRY CLUB
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-1723
Practice Address - Country:US
Practice Address - Phone:787-768-0390
Practice Address - Fax:787-768-1775
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2249103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist