Healthcare Provider Details

I. General information

NPI: 1316343221
Provider Name (Legal Business Name): ALEJANDRA ENID GONZALEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2014
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 AVE HOSTOS STE 205
MAYAGUEZ PR
00680-1503
US

IV. Provider business mailing address

351 AVE HOSTOS STE 205
MAYAGUEZ PR
00680-1503
US

V. Phone/Fax

Practice location:
  • Phone: 787-404-0909
  • Fax:
Mailing address:
  • Phone: 787-404-0909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number018937
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: