Healthcare Provider Details

I. General information

NPI: 1124080718
Provider Name (Legal Business Name): DENIA E. GONZALEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 04/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 PATRON STREET
MOROVIS PR
00687
US

IV. Provider business mailing address

333 CALLE ISLA VERDE URB VILLAS DE LA PLAYA
VEGA BAJA PR
00693-6049
US

V. Phone/Fax

Practice location:
  • Phone: 787-862-3000
  • Fax: 787-862-2731
Mailing address:
  • Phone: 787-807-6252
  • Fax: 787-807-6252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number12325
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: