Healthcare Provider Details

I. General information

NPI: 1619805181
Provider Name (Legal Business Name): GENESIS MONTES GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JARDINES DEL CARIBE CALLE 17 #111 NORTE
PONCE PR
00728
US

IV. Provider business mailing address

1655 CALLE LEONE
PONCE PR
00728-2312
US

V. Phone/Fax

Practice location:
  • Phone: 787-651-6090
  • Fax:
Mailing address:
  • Phone: 787-981-2828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8658
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: