Healthcare Provider Details

I. General information

NPI: 1750925749
Provider Name (Legal Business Name): HILARIE GONZALEZ BURGOS DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2019
Last Update Date: 11/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 152 KM 12.3
NARANJITO PR
00719
US

IV. Provider business mailing address

HC 72 BOX 4010
NARANJITO PR
00719-8780
US

V. Phone/Fax

Practice location:
  • Phone: 939-282-3851
  • Fax:
Mailing address:
  • Phone: 939-292-3851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number696
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: