Provider Demographics
NPI:1811051790
Name:GONZALEZ, SOL EDNITA (PHD)
Entity type:Individual
Prefix:DR
First Name:SOL
Middle Name:EDNITA
Last Name:GONZALEZ
Suffix:
Gender:F
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:PG22 VIA AMANECER
Mailing Address - Street 2:ENCANTADA
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-6148
Mailing Address - Country:US
Mailing Address - Phone:787-565-9891
Mailing Address - Fax:
Practice Address - Street 1:654 AVE MUNOZ RIVERA STE 1735
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-4124
Practice Address - Country:US
Practice Address - Phone:787-565-9891
Practice Address - Fax:787-641-3510
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2109103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical