Healthcare Provider Details

I. General information

NPI: 1750512604
Provider Name (Legal Business Name): JAVIER GONZALEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JAVIER GONZALEZ-CASTRO MD

II. Dates (important events)

Enumeration Date: 07/27/2009
Last Update Date: 10/10/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VILLA CAPARRA 60 CALLE 8
GUAYNABO PR
00966
US

IV. Provider business mailing address

1353 AVE LUIS VIGOREAUX PMB 841
GUAYNABO PR
00966
US

V. Phone/Fax

Practice location:
  • Phone: 787-717-8911
  • Fax:
Mailing address:
  • Phone: 787-717-8911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD165384
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number19036
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number12380
License Number StatePR
# 4
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number19036
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: