1649371451 NPI number — MRS. EDDIE N GONZALEZ SR. PH

Table of content: MRS. EDDIE N GONZALEZ SR. PH (NPI 1649371451)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649371451 NPI number — MRS. EDDIE N GONZALEZ SR. PH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GONZALEZ
Provider First Name:
EDDIE
Provider Middle Name:
N
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
SR.
Provider Credential Text:
PH
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649371451
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9906
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARECIBO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00613-9906
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-880-4806
Provider Business Mailing Address Fax Number:
787-878-2065

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR.635 K.0.1 BO.DOMINGUITO
Provider Second Line Business Practice Location Address:
BOX 9906
Provider Business Practice Location Address City Name:
ARECIBO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-880-4806
Provider Business Practice Location Address Fax Number:
787-878-2065
Provider Enumeration Date:
09/26/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183700000X , with the licence number:  000815 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)