Provider Demographics
NPI:1760685440
Name:CANGIANO, JOSE ENRIQUE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ENRIQUE
Last Name:CANGIANO
Suffix:
Gender:M
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:PO BOX 32109
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-2109
Mailing Address - Country:US
Mailing Address - Phone:787-840-7671
Mailing Address - Fax:787-840-7671
Practice Address - Street 1:36 CALLE ESTRELLA
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-3832
Practice Address - Country:US
Practice Address - Phone:787-840-7671
Practice Address - Fax:787-840-7671
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR205103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR87697Medicare ID - Type UnspecifiedPSYCHOLOGIST