Healthcare Provider Details

I. General information

NPI: 1083764245
Provider Name (Legal Business Name): GERARDO A GONZALEZ P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 09/17/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 AVE LOS VETERANOS
LAJAS PR
00667-2509
US

IV. Provider business mailing address

13914 CONDOMINIO PLAYA BUYE APT 112
CABO ROJO PR
00623
US

V. Phone/Fax

Practice location:
  • Phone: 787-899-4242
  • Fax: 787-899-4242
Mailing address:
  • Phone: 787-851-4894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number001651
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: