Healthcare Provider Details

I. General information

NPI: 1306908215
Provider Name (Legal Business Name): GIOVANNI GONZALEZ SR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE ELLIOT VELEZ B 42 URBANIZACION ATENAS
MANATI PR
00674
US

IV. Provider business mailing address

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:
Title or Position:
Credential:
Phone: