Provider Demographics
NPI:1609582212
Name:DIAZ GONZALEZ, LINEZKA ZOE (LIC)
Entity Type:Individual
Prefix:
First Name:LINEZKA
Middle Name:ZOE
Last Name:DIAZ GONZALEZ
Suffix:
Gender:F
Credentials:LIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 2 BOX 12445
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-8263
Mailing Address - Country:US
Mailing Address - Phone:939-292-2422
Mailing Address - Fax:
Practice Address - Street 1:CARR #2 KM 98.7 INTE. CARR 110 PROFESSIONAL PLAZA
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-517-2024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7528101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health