1619930682 NPI number — JOSE RAMON GONZALEZ CHAVEZ M.D.

Table of content: ALAWN LOGAN (NPI 1982192704)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619930682 NPI number — JOSE RAMON GONZALEZ CHAVEZ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GONZALEZ CHAVEZ
Provider First Name:
JOSE
Provider Middle Name:
RAMON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1619930682
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
138 AVE WINSTON CHURCHILL
Provider Second Line Business Mailing Address:
SUITE#423
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00926-6013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-460-0478
Provider Business Mailing Address Fax Number:
787-761-4318

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SANTURCE MEDICAL MALL AVE.PONCE DE LEON 1801
Provider Second Line Business Practice Location Address:
SUITE#302
Provider Business Practice Location Address City Name:
SANTURCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-727-0060
Provider Business Practice Location Address Fax Number:
787-761-4318
Provider Enumeration Date:
04/10/2006

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: 207N00000X , with the licence number:  5737 , 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: 26193 . This is a "MEDICARE PROVIDER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 27226 . This is a "MEDICARE NUMBER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 5737 . This is a "STATE LICENCE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




Copyright © 2007-2026 www.npivalidator.com