Provider Demographics
NPI:1801929070
Name:GONZALEZ, VICTOR M (PSYCHOLGY)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:M
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:PSYCHOLGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:REPARTO MONTELLANO CALLE BD5
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736-1768
Mailing Address - Country:US
Mailing Address - Phone:787-557-8176
Mailing Address - Fax:
Practice Address - Street 1:1324 CALLE CANADA FINAL ANTIGUO HOSPITAL VETERANO
Practice Address - Street 2:PUERTO NUEVO S
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:09020-3860
Practice Address - Country:US
Practice Address - Phone:787-557-8176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2465103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical