1962552968 NPI number — MANUEL ANTONIO GONZALEZ RODRIGUEZ MD

Table of content: MANUEL ANTONIO GONZALEZ RODRIGUEZ MD (NPI 1962552968)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962552968 NPI number — MANUEL ANTONIO GONZALEZ RODRIGUEZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GONZALEZ RODRIGUEZ
Provider First Name:
MANUEL
Provider Middle Name:
ANTONIO
Provider Name Prefix Text:
Provider Name Suffix Text:
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:
1962552968
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
92 CALLE ALHAMBRA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAYAGUEZ
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00680-1401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-834-3142
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9 CALLE SOL
Provider Second Line Business Practice Location Address:
BOX 287
Provider Business Practice Location Address City Name:
SAN GERMAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00683-3950
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-892-4033
Provider Business Practice Location Address Fax Number:
787-892-6130
Provider Enumeration Date:
01/11/2007

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:  4251 , 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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