Healthcare Provider Details

I. General information

NPI: 1861256927
Provider Name (Legal Business Name): EDGARDO RUBEN GONZALEZ-GARCIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2024
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. 917 KM. 0.1 SEC. EULOGIO REYES BO. TEJAS
LAS PIEDRAS PR
00771
US

IV. Provider business mailing address

PO BOX 565
HUMACAO PR
00792-0565
US

V. Phone/Fax

Practice location:
  • Phone: 787-328-2127
  • Fax:
Mailing address:
  • Phone: 787-328-2127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number38282
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: