Healthcare Provider Details

I. General information

NPI: 1538983846
Provider Name (Legal Business Name): ORLANDO J GONZALEZ EMT-P
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2024
Last Update Date: 11/13/2024
Certification Date: 11/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

367 CALLE RAMON E. BETANCES, APT 6
MAYAGUEZ PR
00680-0068
US

IV. Provider business mailing address

367 CALLE RAMON E. BETANCES, APT 6
MAYAGUEZ PR
00680
US

V. Phone/Fax

Practice location:
  • Phone: 939-238-5828
  • Fax:
Mailing address:
  • Phone: 939-238-5828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number4064
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: