Healthcare Provider Details

I. General information

NPI: 1164540605
Provider Name (Legal Business Name): MRS. CARMEN P GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 129 BARRIO BAYANLEY FARMACIA SAN FELIPE
HATILLO PR
00659
US

IV. Provider business mailing address

CALLE PEDRO ALBIZU CAMPOS #197
LARES PR
00669
US

V. Phone/Fax

Practice location:
  • Phone: 787-898-6378
  • Fax:
Mailing address:
  • Phone: 787-384-6583
  • Fax: 787-897-2953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number3789
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: