1215044979 NPI number — DR. JUAN A GONZALEZ SKERRETT MD

Table of content: DR. JUAN A GONZALEZ SKERRETT MD (NPI 1215044979)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215044979 NPI number — DR. JUAN A GONZALEZ SKERRETT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GONZALEZ SKERRETT
Provider First Name:
JUAN A
Provider Middle Name:
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:
GONZALEZ SKERRETT
Provider Other First Name:
JUAN A
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1215044979
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:
CALLE PEPITA ALBANDOZ NUM 66
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANOVANAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00729
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-256-2831
Provider Business Mailing Address Fax Number:
787-256-2831

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE PEPITA ALBANDOZ
Provider Second Line Business Practice Location Address:
NUMBER 66
Provider Business Practice Location Address City Name:
CANOVANAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00729-1707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-256-2831
Provider Business Practice Location Address Fax Number:
787-256-2831
Provider Enumeration Date:
08/25/2006

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: 261QP2300X , with the licence number:  10390 , 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: 060378 . This is a "CRUZ AZUL DE PUERTO RICO" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 2122 . This is a "PREFERRED MEDICARE CHOICE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 7450021 . This is a "HUMANA DE PUERTO RICO" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: PG-2007 . This is a "PAN AMERICAN LIFE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 1262 . This is a "FIRST MEDICAL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 82495 . This is a "TRIPLE S" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 7450021 . This is a "HUMANA GOLD CHOICE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 01738 . This is a "AMERICAN HEALTH INC" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 201105 . This is a "PREFERRED UTI" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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