MEDICARE: YESIMAR GONZALEZ III

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	183700000X	Pharmacy Technician	5161	PR

General Provider Information

NPI Number	:	1588824999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YESIMAR GONZALEZ III

Provider Business Mailing Address
First Line	:	250D CALLE 30
Second Line	:	PARCELAS FALU
City	:	SAN JUAN
State	:	PR
Zip	:	00924-3133
Country	:	US
Telephone Number	:	787-758-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	250D CALLE 30
Second Line	:	PARCELAS FALU
City	:	SAN JUAN
State	:	PR
Zip	:	00924-3133
Country	:	US
Telephone Number	:	787-758-2000
Fax Number	:

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

Provider Enumeration Date	:	06/10/2008
Last Update Date	:	06/10/2008

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Directions to “ YESIMAR GONZALEZ III ” Practice Location

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