1720388085 NPI number — MRS. IVETTE J GONZALEZ CORREA MSW

Table of content: MRS. IVETTE J GONZALEZ CORREA MSW (NPI 1720388085)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720388085 NPI number — MRS. IVETTE J GONZALEZ CORREA MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GONZALEZ CORREA
Provider First Name:
IVETTE
Provider Middle Name:
J
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GONZALEZ CORREA
Provider Other First Name:
IVETTE
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1720388085
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 560636
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GUAYANILLA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00656-3636
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-405-3043
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CENTRO COMERCIAL PLAZA MONSERRATE II
Provider Second Line Business Practice Location Address:
CARR 345 KM 2.1 LOCAL 7 Y 8 OFIC 1
Provider Business Practice Location Address City Name:
HORMIGUEROS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00660-9998
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-806-1835
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/02/2010

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:  7682 , 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)





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