Healthcare Provider Details

I. General information

NPI: 1053476507
Provider Name (Legal Business Name): ENRIQUE FRANCISCO BOSCH-GONSALVEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 11/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 CALLE SANTA CRUZ INST. SAN PABLO SUITE 410
BAYAMON PR
00961-7041
US

IV. Provider business mailing address

PO BOX 9098
BAYAMON PR
00960-9098
US

V. Phone/Fax

Practice location:
  • Phone: 787-786-9008
  • Fax:
Mailing address:
  • Phone: 787-786-9008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number6332
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: