Provider Demographics
NPI:1952431314
Name:GONZALEZ, PETER JOE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:JOE
Last Name:GONZALEZ
Suffix:
Gender:M
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:H24 CALLE MIGUEL A GOMEZ
Mailing Address - Street 2:IDAMARIS GARDENS
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-5718
Mailing Address - Country:US
Mailing Address - Phone:787-632-7244
Mailing Address - Fax:
Practice Address - Street 1:FIRST HOSPITAL PANAMERICANO
Practice Address - Street 2:STATE ROAD, 787, KM. 1.5
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739-1400
Practice Address - Country:US
Practice Address - Phone:787-739-5555
Practice Address - Fax:787-739-5544
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2111103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical