Provider Demographics
NPI:1447135124
Name:MARTINEZ AGOSTO, GAMALIEL (MS)
Entity type:Individual
Prefix:
First Name:GAMALIEL
Middle Name:
Last Name:MARTINEZ AGOSTO
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 948776
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00694-8776
Mailing Address - Country:US
Mailing Address - Phone:787-688-9441
Mailing Address - Fax:
Practice Address - Street 1:CARR. 695 KM 1.6 BO. HIGUILLAR
Practice Address - Street 2:URB. DORAVILEE
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646
Practice Address - Country:US
Practice Address - Phone:787-391-6951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8448103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling