Healthcare Provider Details

I. General information

NPI: 1588623185
Provider Name (Legal Business Name): NORMAN GONZALEZ CASIANO M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 114 KM 5.4 BO LAJAS ARRIBA
LAJAS PR
00667
US

IV. Provider business mailing address

PO BOX 713
YAUCO PR
00698-0713
US

V. Phone/Fax

Practice location:
  • Phone: 787-804-3359
  • Fax:
Mailing address:
  • Phone: 787-821-6053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number14521
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: