Provider Demographics
NPI:1770836447
Name:GONZALEZ RODRIGUEZ, LUZ YIRAIDA (PHD)
Entity Type:Individual
Prefix:DR
First Name:LUZ
Middle Name:YIRAIDA
Last Name:GONZALEZ RODRIGUEZ
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:PO BOX 697
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-0697
Mailing Address - Country:US
Mailing Address - Phone:787-957-6608
Mailing Address - Fax:
Practice Address - Street 1:PASEO SAN ISIDRO SUITE 2
Practice Address - Street 2:CARR. 188 KM 2.0, ESQUINA C/6 Y C6A, SAN ISIDRO
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-0000
Practice Address - Country:US
Practice Address - Phone:787-368-4614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4276103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling