MEDICARE: AMPARO GONZALEZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	4858	PR

General Provider Information

NPI Number	:	1013110279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMPARO GONZALEZ M.D.

Provider Business Mailing Address
First Line	:	E17 CALLE 7
Second Line	:	ESTANCIAS DE SAN FERNANDO
City	:	CAROLINA
State	:	PR
Zip	:	00985-5218
Country	:	US
Telephone Number	:	787-768-0282
Fax Number	:

Provider Business Practice Location Address
First Line	:	E17 CALLE 7
Second Line	:	ESTANCIAS DE SAN FERNANDO
City	:	CAROLINA
State	:	PR
Zip	:	00985-5218
Country	:	US
Telephone Number	:	787-768-0282
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2007
Last Update Date	:	07/08/2007

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