Active NPI
Ileana K Burgos Gomez, PSYD.
- Clinical Psychologist
- Bayamon, PR
National Provider Identifier
1497389290
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6463
- Practice address
- Metro Medical Center
Suite a 801 Torre a 995 PR-2
Bayamon, PR 00959 - Phone
- (787) 672-5384
- NPI assigned
- Mar 2, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 6463 | PR | Primary |
Addresses
Primary practice location
Metro Medical Center
Suite a 801 Torre a 995 PR-2
Bayamon, PR 00959
Mailing address
HC 2 Box 6159
Bajadero, PR 00616-9761
Phone (787) 983-9161
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6463 | PR | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1583107200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1641254400000",
"number": "1497389290",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "HC 2 BOX 6159",
"city": "BAJADERO",
"state": "PR",
"postal_code": "006169761",
"telephone_number": "787-983-9161"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "METRO MEDICAL CENTER",
"address_2": "SUITE A 801 TORRE A 995 PR-2",
"city": "BAYAMON",
"state": "PR",
"postal_code": "00959",
"telephone_number": "787-672-5384"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURGOS GOMEZ",
"first_name": "ILEANA",
"middle_name": "K",
"name_prefix": "Dr.",
"credential": "PSYD.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-03-02",
"last_updated": "2022-01-04",
"certification_date": "2021-12-30",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "PR",
"license": "6463",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bayamon, PR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.