Provider Demographics
NPI:1831878834
Name:GORDILS GALARZA, DESIREE
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:GORDILS GALARZA
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:AVE. JOSEFINA LEGRANDM 66 B, ESQUINA PALMER
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-9991
Mailing Address - Country:US
Mailing Address - Phone:787-903-3863
Mailing Address - Fax:
Practice Address - Street 1:AVE. JOSEFINA LEGRANDM 66 B, ESQUINA PALMER
Practice Address - Street 2:
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-9991
Practice Address - Country:US
Practice Address - Phone:787-903-3863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8158103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical