Healthcare Provider Details

I. General information

NPI: 1316768765
Provider Name (Legal Business Name): ADRIANA PAOLA GONZALEZ FRONTERA STUDENT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2024
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. NUM.2, KM. 11.7
BAYAMON PR
00959
US

IV. Provider business mailing address

SALA PONCE, 388 CALLE LUIS F
PONCE PR
00716
US

V. Phone/Fax

Practice location:
  • Phone: 787-474-8282
  • Fax:
Mailing address:
  • Phone: 787-840-2575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: