Healthcare Provider Details

I. General information

NPI: 1134281926
Provider Name (Legal Business Name): MATERNITY GYN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

B42 CALLE ELLIOT VELEZ URBANIZACION ATENAS
MANATI PR
00674
US

IV. Provider business mailing address

PO BOX 9784 COTTO STATION
ARECIBO PR
00613-9784
US

V. Phone/Fax

Practice location:
  • Phone: 787-854-7531
  • Fax: 787-884-8753
Mailing address:
  • Phone: 787-854-7531
  • Fax: 787-884-8753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number8124
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier04578
Identifier TypeOTHER
Identifier State
Identifier IssuerAMERICAN HEALTH INC
# 2
Identifier069557
Identifier TypeOTHER
Identifier State
Identifier IssuerCRUZ AZUL

VIII. Authorized Official

Name: DR. GIOVANNI GONZALEZ
Title or Position: PRESIDENT
Credential: MD
Phone: 787-854-7531