1992982334 NPI number — MR. LUDGARDO FERMIN GONZALEZ MARIN SR. MD

Table of content: MR. LUDGARDO FERMIN GONZALEZ MARIN SR. MD (NPI 1992982334)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992982334 NPI number — MR. LUDGARDO FERMIN GONZALEZ MARIN SR. MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GONZALEZ MARIN
Provider First Name:
LUDGARDO
Provider Middle Name:
FERMIN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
SR.
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:
1992982334
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
290 SANTA ANA AVENUE
Provider Second Line Business Mailing Address:
BUZON 39 TORRIMAR TOWN PARK APTO B-203
Provider Business Mailing Address City Name:
GUAYNABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00969-3361
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-585-5518
Provider Business Mailing Address Fax Number:
787-790-1304

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
51-46 MAIN AVENUE
Provider Second Line Business Practice Location Address:
URBANIZACION SANTA ROSA 2DO PISO
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00959
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-585-5518
Provider Business Practice Location Address Fax Number:
787-798-5275
Provider Enumeration Date:
01/29/2008

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: 261QM0801X , with the licence number:  5062PUERTORICO , 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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