Provider Demographics
NPI:1639447089
Name:GONZALEZ ORTIZ, LILLIAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:LILLIAN
Middle Name:
Last Name:GONZALEZ ORTIZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MONTERREY EST
Mailing Address - Street 2:9 AVE LAGUNA, APT 121
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979-6445
Mailing Address - Country:US
Mailing Address - Phone:787-365-8616
Mailing Address - Fax:
Practice Address - Street 1:MONTERREY EST
Practice Address - Street 2:9 AVE LAGUNA, APT 121
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00979-6445
Practice Address - Country:US
Practice Address - Phone:787-365-8616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-13
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR628103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR628OtherPROFESSIONAL STATE LICENSE