Healthcare Provider Details

I. General information

NPI: 1083390975
Provider Name (Legal Business Name): LISMARI CHARITY GONZALEZ SANTOS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 306
BAYAMON PR
00960-0306
US

IV. Provider business mailing address

BRISAS DEL CAMPANERO 1 CALLE ISAIAS F-25 BUZON 572
TOA BAJA PR
00949
US

V. Phone/Fax

Practice location:
  • Phone: 787-620-8181
  • Fax:
Mailing address:
  • Phone: 939-400-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number17751
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: