Provider Demographics
NPI:1023434750
Name:DR.HIGINIO A GONZALEZ PSYD:SERVICIOS PSICOLOGICOS Y PSICOEDUCATIVOS CS
Entity type:Organization
Organization Name:DR.HIGINIO A GONZALEZ PSYD:SERVICIOS PSICOLOGICOS Y PSICOEDUCATIVOS CS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:HIGINIO
Authorized Official - Middle Name:A
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-675-9868
Mailing Address - Street 1:URB. VILLA MILAGROS B-15
Mailing Address - Street 2:
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698
Mailing Address - Country:US
Mailing Address - Phone:787-675-9868
Mailing Address - Fax:787-259-5995
Practice Address - Street 1:SECTOR CUATRO CALLES SUITE # 7
Practice Address - Street 2:EDIF. PROFESIONAL
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698
Practice Address - Country:US
Practice Address - Phone:787-675-9868
Practice Address - Fax:787-259-5995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-05
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR002331261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR002331OtherLICENCIA
PR103TC0700XOtherPROVIDER TAXONOMIES
PR002331OtherLICENCIA