1720084171 NPI number — DR. IVAN F GONZALEZ-CANCEL MD

Table of content: DR. IVAN F GONZALEZ-CANCEL MD (NPI 1720084171)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720084171 NPI number — DR. IVAN F GONZALEZ-CANCEL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GONZALEZ-CANCEL
Provider First Name:
IVAN
Provider Middle Name:
F
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1720084171
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PMB NUM 476
Provider Second Line Business Mailing Address:
PO BOX 70344
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00936-8344
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-281-0451
Provider Business Mailing Address Fax Number:
787-281-0450

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVE AMERICO MIRANDA
Provider Second Line Business Practice Location Address:
NUM 401
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-281-0451
Provider Business Practice Location Address Fax Number:
787-281-0450
Provider Enumeration Date:
06/21/2005

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: 208G00000X , with the licence number:  9454 , 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)

  • Identifier: 069976 . This is a "CA PROVIDER NUMBER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: N791 . This is a "IMC PROVIDER NUMBER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 1691 . This is a "PMC PROVIDER NUMBER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 5709454 . This is a "UIA PROVIDER NUMBER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 83286 . This is a "SSS PROVIDER NUMBER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 8000327 . This is a "HUMANA PROVIDER NUMBER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 83286GO . This is a "SSS PROVIDER NUMBER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 0204042 . This is a "UTI PROVIDER NUMBER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 600087 . This is a "MMM PROVIDER NUMBER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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