Provider Demographics
NPI:1962024364
Name:GONZALEZ VARGAS, KEYSHA M (MD)
Entity Type:Individual
Prefix:
First Name:KEYSHA
Middle Name:M
Last Name:GONZALEZ VARGAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. SANTA CECILIA
Mailing Address - Street 2:54 CALLE BEATO JOS MARA ESCRIVA
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-746-1971
Mailing Address - Fax:
Practice Address - Street 1:URB. SANTA CECILIA 54
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-746-1971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-08
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling