Provider Demographics
NPI:1518542794
Name:GONZALEZ, SHAKIRA J
Entity Type:Individual
Prefix:MISS
First Name:SHAKIRA
Middle Name:J
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1054 JOAQUIN LOPEZ URB. SANTA RITA
Mailing Address - Street 2:APT 3
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00925
Mailing Address - Country:US
Mailing Address - Phone:939-206-3581
Mailing Address - Fax:
Practice Address - Street 1:1054 JOAQUIN LOPEZ URB. SANTA RITA
Practice Address - Street 2:APT 3
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925
Practice Address - Country:US
Practice Address - Phone:939-206-3581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1041S0200X1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool