Healthcare Provider Details

I. General information

NPI: 1376505586
Provider Name (Legal Business Name): ALTAGRACIA A ALCANTARA GONZALEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TT14 CALLE 37 SANTA JUANITA
BAYAMON PR
00956-4741
US

IV. Provider business mailing address

97 CALLE AZALEA CIUDAD JARDIN I
TOA ALTA PR
00953-4846
US

V. Phone/Fax

Practice location:
  • Phone: 787-787-0933
  • Fax: 956-948-6000
Mailing address:
  • Phone: 787-787-0933
  • Fax: 956-948-6000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number11898
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number11898
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: