Provider Demographics
NPI:1538883525
Name:GONZALEZ RODRIGUEZ, CARMIRA JAZMIN
Entity type:Individual
Prefix:
First Name:CARMIRA
Middle Name:JAZMIN
Last Name:GONZALEZ RODRIGUEZ
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:CARRETERA 135, KM 4.5
Mailing Address - Street 2:BARRIO BARTOLO, SECTOR CASTANER
Mailing Address - City:LARES
Mailing Address - State:PR
Mailing Address - Zip Code:00631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 135, KM 4.5
Practice Address - Street 2:BARRIO BARTOLO, SECTOR CASTANER
Practice Address - City:LARES
Practice Address - State:PR
Practice Address - Zip Code:00631
Practice Address - Country:US
Practice Address - Phone:787-829-5010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR145841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical