Provider Demographics
NPI:1609582212
Name:DIAZ GONZALEZ, LINEZKA ZOE (LIC)
Entity type:Individual
Prefix:
First Name:LINEZKA
Middle Name:ZOE
Last Name:DIAZ GONZALEZ
Suffix:
Gender:
Credentials:LIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 2 BOX 12445
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-8263
Mailing Address - Country:US
Mailing Address - Phone:939-200-7165
Mailing Address - Fax:
Practice Address - Street 1:301 CALLE JOSE C. BARBOSA
Practice Address - Street 2:
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676
Practice Address - Country:US
Practice Address - Phone:939-200-7165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-26
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7528101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health