Provider Demographics
NPI:1710728225
Name:GONZALEZ VIRUET, OLGA IRIS (PSYD)
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:IRIS
Last Name:GONZALEZ VIRUET
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 LA REPRESA
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-6913
Mailing Address - Country:US
Mailing Address - Phone:787-454-7955
Mailing Address - Fax:
Practice Address - Street 1:101 AVE SAN PATRICIO STE 1240
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968-3057
Practice Address - Country:US
Practice Address - Phone:787-454-7955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-06
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7954103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical