Healthcare Provider Details

I. General information

NPI: 1316934557
Provider Name (Legal Business Name): JOANNE GONZALEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 CARR 2 STE 608
BAYAMON PR
00959-7204
US

IV. Provider business mailing address

PO BOX 1829
CIALES PR
00638-1829
US

V. Phone/Fax

Practice location:
  • Phone: 787-212-8289
  • Fax:
Mailing address:
  • Phone: 787-212-8289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number14783
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: