Provider Demographics
NPI:1124443270
Name:GOMILA ROMERO, ILCHA L (PHD)
Entity type:Individual
Prefix:DR
First Name:ILCHA
Middle Name:L
Last Name:GOMILA ROMERO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:D8 PLAZA 12 URB. CAMBRIDGE PARK
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-1450
Mailing Address - Country:US
Mailing Address - Phone:787-637-6509
Mailing Address - Fax:
Practice Address - Street 1:20 CALLE PINEIRO URB. PINEIRO
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-637-6509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-26
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5459103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical