1306908215 NPI number — MR. GIOVANNI GONZALEZ SR. MD

Table of content: MR. GIOVANNI GONZALEZ SR. MD (NPI 1306908215)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306908215 NPI number — MR. GIOVANNI GONZALEZ SR. MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GONZALEZ
Provider First Name:
GIOVANNI
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
SR.
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:
1306908215
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:
BOX 9784
Provider Second Line Business Mailing Address:
COTTO STATION
Provider Business Mailing Address City Name:
ARECIBO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00613-9784
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-854-7531
Provider Business Mailing Address Fax Number:
787-884-8753

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE ELLIOT VELEZ B 42
Provider Second Line Business Practice Location Address:
URBANIZACION ATENAS
Provider Business Practice Location Address City Name:
MANATI
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00674
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-854-7531
Provider Business Practice Location Address Fax Number:
787-884-8753
Provider Enumeration Date:
12/15/2006

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: 207V00000X , with the licence number:  8124 , 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: 04578 . This is a "AMERICAN HEALTH INC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 069557 . This is a "CRUZ AZUL" identifier . This identifiers is of the category "OTHER".




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