Healthcare Provider Details

I. General information

NPI: 1295939312
Provider Name (Legal Business Name): MRS. ZAIDA I GONZALEZ RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 02/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 568 KM 29.9
COROZAL PR
00783
US

IV. Provider business mailing address

HC 5 BOX 11195
COROZAL PR
00783-9590
US

V. Phone/Fax

Practice location:
  • Phone: 787-312-9416
  • Fax: 787-854-1452
Mailing address:
  • Phone: 787-312-9416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number4381
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: