Provider Demographics
NPI:1174946917
Name:GAUD, RAQUEL ISAHI
Entity type:Individual
Prefix:
First Name:RAQUEL
Middle Name:ISAHI
Last Name:GAUD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ALELI 5014
Mailing Address - Street 2:URB. BUENAVENTURA
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680
Mailing Address - Country:US
Mailing Address - Phone:787-344-3534
Mailing Address - Fax:
Practice Address - Street 1:212 CALLE VENTURA GANDARILLA
Practice Address - Street 2:COMUNIDAD BUENOS AIRES
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-4808
Practice Address - Country:US
Practice Address - Phone:787-344-3534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR005456103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist