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

Table of content: JOSE RAMON GONZALEZ CHAVEZ M.D. (NPI 1619930682)

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".




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