Provider Demographics
NPI:1689111791
Name:GONZALEZ, JULIA ISABEL (PHD)
Entity Type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:ISABEL
Last Name:GONZALEZ
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 1:370 CALLE 10
Mailing Address - Street 2:ANDREA'S COURT APT.7
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976
Mailing Address - Country:US
Mailing Address - Phone:787-447-0510
Mailing Address - Fax:
Practice Address - Street 1:867 AVE. MUNOZ RIVERA
Practice Address - Street 2:EDIF VICK CENTERSUITE 206-D
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925
Practice Address - Country:US
Practice Address - Phone:939-257-2973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5675103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical