1225177645 NPI number — LUIS F GONZALEZ DM

Table of content: LUIS F GONZALEZ DM (NPI 1225177645)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225177645 NPI number — LUIS F GONZALEZ DM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GONZALEZ
Provider First Name:
LUIS
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DM
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:
1225177645
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 800
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAROLINA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00986-0800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-363-9378
Provider Business Mailing Address Fax Number:
787-276-2923

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 857 KM 0.4 BO CANOVANILLAS
Provider Second Line Business Practice Location Address:
DENTALIA MEDIKA CORP
Provider Business Practice Location Address City Name:
CAROLINA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00987-0800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-363-9378
Provider Business Practice Location Address Fax Number:
787-276-2923
Provider Enumeration Date:
02/05/2007

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: 1223G0001X , with the licence number:  1272 , 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: 1272 . This is a "DENTIST LICENCES" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com