MEDICARE: GENESIS MONTES GONZALEZ

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	183500000X	Pharmacist	8658	PR

General Provider Information

NPI Number	:	1619805181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GENESIS MONTES GONZALEZ

Provider Business Mailing Address
First Line	:	1655 CALLE LEONE
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00728-2312
Country	:	US
Telephone Number	:	787-981-2828
Fax Number	:

Provider Business Practice Location Address
First Line	:	JARDINES DEL CARIBE CALLE 17 #111 NORTE
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00728
Country	:	US
Telephone Number	:	787-651-6090
Fax Number	:

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

Provider Enumeration Date	:	05/13/2026
Last Update Date	:	05/13/2026

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