Healthcare Provider Details

I. General information

NPI: 1194345934
Provider Name (Legal Business Name): TAMARA TRINIDAD GONZALEZ CPM, MSM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2020
Last Update Date: 04/22/2020
Certification Date: 04/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 CARR 1 KM 29 REPARTO SOLANO
CAGUAS PR
00725
US

IV. Provider business mailing address

HC 5 PO BOX 8085 EL VERDE
RIO GRANDE PR
00745
US

V. Phone/Fax

Practice location:
  • Phone: 787-585-4915
  • Fax:
Mailing address:
  • Phone: 787-585-4915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: