Provider Demographics
NPI:1336189430
Name:SOTO GINES, GRETCHEN (PSYD)
Entity Type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:
Last Name:SOTO GINES
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:G12 CALLE SAN JACINTO
Mailing Address - Street 2:URB EL ALAMO
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-4515
Mailing Address - Country:US
Mailing Address - Phone:787-272-8026
Mailing Address - Fax:
Practice Address - Street 1:G12 CALLE SAN JACINTO
Practice Address - Street 2:URB EL ALAMO
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-4515
Practice Address - Country:US
Practice Address - Phone:787-272-8026
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1245103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical