Healthcare Provider Details

I. General information

NPI: 1144367103
Provider Name (Legal Business Name): EVELYN GONZALEZ DEL RIO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 CALLE JUAN SAN ANTONIOEDF BOSQUES #9
MOCA PR
00676
US

IV. Provider business mailing address

RR04 BUZON 5056
ANASCO PR
00610
US

V. Phone/Fax

Practice location:
  • Phone: 787-818-2065
  • Fax: 787-818-2065
Mailing address:
  • Phone: 787-818-2065
  • Fax: 787-818-2065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number11702
License Number StatePR

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: