Provider Demographics
NPI:1912220658
Name:AGOSTINI, LUIS GABRIEL (PHD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:GABRIEL
Last Name:AGOSTINI
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 1:178 CALLE CATALONIA
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-1006
Mailing Address - Country:US
Mailing Address - Phone:787-525-4236
Mailing Address - Fax:
Practice Address - Street 1:#36 CORPORATE OFFICE PARK
Practice Address - Street 2:ASG BUILDING SUITE 301
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966
Practice Address - Country:US
Practice Address - Phone:787-800-9294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-09
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3491103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist