1548825706 NPI number — DR. MELY Z GONZALEZ MADERA CLINICAL SOCIAL WORK

Table of content: DR. MELY Z GONZALEZ MADERA CLINICAL SOCIAL WORK (NPI 1548825706)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548825706 NPI number — DR. MELY Z GONZALEZ MADERA CLINICAL SOCIAL WORK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GONZALEZ MADERA
Provider First Name:
MELY
Provider Middle Name:
Z
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
CLINICAL SOCIAL WORK
Provider Gender Code:
F

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:
1548825706
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
URB VILLAS DE LA CENTRAL VICTORIA
Provider Second Line Business Mailing Address:
17 CALLE ESCARPIA
Provider Business Mailing Address City Name:
JUNCOS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00777-0000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-204-7699
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
307 AVENIDA ORTEGON 107
Provider Second Line Business Practice Location Address:
CAPARRA GALLERY
Provider Business Practice Location Address City Name:
GUAYNABO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00965-2505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-204-7699
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/03/2019

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: 1041C0700X , with the licence number:  11858 , 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: 39793900 , issued by the state of ( PR ) . This identifiers is of the category "MEDICAID".




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