Provider Demographics
NPI:1255609129
Name:GONZALEZ, SAYRA CORAL (PSYD)
Entity type:Individual
Prefix:DR
First Name:SAYRA
Middle Name:CORAL
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2070 CALLE 1 LOS FRAILES GARDENS APT 5303E
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-2409
Mailing Address - Country:US
Mailing Address - Phone:939-940-8396
Mailing Address - Fax:
Practice Address - Street 1:2070 CALLE 1 LOS FRAILES GARDENS APT 5303E
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966-2409
Practice Address - Country:US
Practice Address - Phone:939-940-8396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-07
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3881103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical