1427048578 NPI number — DR. ANDREA GONZALEZ DUENAS MD

Table of content: DR. ANDREA GONZALEZ DUENAS MD (NPI 1427048578)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427048578 NPI number — DR. ANDREA GONZALEZ DUENAS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GONZALEZ DUENAS
Provider First Name:
ANDREA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GONZALEZ DUENAS
Provider Other First Name:
ANDREA
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:
2

NPI Number Information

NPI Number:
1427048578
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:
DEL PARQUE 218 APTO. 4-A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTURCE
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00911
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-722-5355
Provider Business Mailing Address Fax Number:
787-761-1724

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
A10 CALLE TREVISO
Provider Second Line Business Practice Location Address:
TOWN PARK
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00924-5023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-761-1728
Provider Business Practice Location Address Fax Number:
787-761-1724
Provider Enumeration Date:
10/28/2005

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: 2084P0800X , with the licence number:  8940 , 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: 060581 . This is a "PSYCHIATRIST" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 87950 . This is a "PSYCHIATRIST" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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