Healthcare Provider Details

I. General information

NPI: 1215044979
Provider Name (Legal Business Name): JUAN A GONZALEZ SKERRETT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JUAN A GONZALEZ SKERRETT MD

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE PEPITA ALBANDOZ NUMBER 66
CANOVANAS PR
00729-1707
US

IV. Provider business mailing address

CALLE PEPITA ALBANDOZ NUM 66
CANOVANAS PR
00729
US

V. Phone/Fax

Practice location:
  • Phone: 787-256-2831
  • Fax: 787-256-2831
Mailing address:
  • Phone: 787-256-2831
  • Fax: 787-256-2831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number10390
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: