Healthcare Provider Details

I. General information

NPI: 1013131069
Provider Name (Legal Business Name): VANGIE GONZALEZ M.T
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

V1 CALLE 16 URB. VILLA LOS SANTOS
ARECIBO PR
00612-3112
US

IV. Provider business mailing address

VILLA ALEGRIA 291 TURQUESA
AGUADILLA PR
00603
US

V. Phone/Fax

Practice location:
  • Phone: 787-879-1609
  • Fax: 787-880-3733
Mailing address:
  • Phone: 787-882-2107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number5716
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: