Healthcare Provider Details

I. General information

NPI: 1487864716
Provider Name (Legal Business Name): ISMAEL GONZALEZ DELGADO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 CALLE ANDRES OLIVER
ARECIBO PR
00612-4330
US

IV. Provider business mailing address

PO BOX 2722
ARECIBO PR
00613-2722
US

V. Phone/Fax

Practice location:
  • Phone: 787-817-7854
  • Fax:
Mailing address:
  • Phone: 787-817-7854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080H0002X
TaxonomyPediatric Hospice and Palliative Medicine Physician
License Number11376
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: