Healthcare Provider Details

I. General information

NPI: 1942849849
Provider Name (Legal Business Name): JOSHUA RAFAEL GONZALEZ CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2019
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE DOCTOR BARBOSA # 15
MAYAGUEZ PR
00681
US

IV. Provider business mailing address

PO BOX 3157
CAGUAS PR
00726-3157
US

V. Phone/Fax

Practice location:
  • Phone: 787-834-0101
  • Fax:
Mailing address:
  • Phone: 787-239-7449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number11005124
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: