Healthcare Provider Details

I. General information

NPI: 1023095072
Provider Name (Legal Business Name): SAINT MICHAEL MED SERV INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MARGINAL B 10 URB FLAMBOYAN
MANATI PR
00674
US

IV. Provider business mailing address

PO BOX 1729
VEGA BAJA PR
00694-1729
US

V. Phone/Fax

Practice location:
  • Phone: 787-854-1357
  • Fax: 787-854-1357
Mailing address:
  • Phone: 787-854-1357
  • Fax: 787-854-1357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: BERNARDO A GONZALEZ
Title or Position: PRESIDENT
Credential: MD
Phone: 787-854-1357