Healthcare Provider Details

I. General information

NPI: 1275591489
Provider Name (Legal Business Name): ROBERTO GONZALEZ GONZALEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 05/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SALUD AVE. #1326 SUITE 511
PONCE PR
00717-1689
US

IV. Provider business mailing address

PO BOX 7214
PONCE PR
00732-7214
US

V. Phone/Fax

Practice location:
  • Phone: 787-844-5980
  • Fax: 787-844-5999
Mailing address:
  • Phone: 787-844-5980
  • Fax: 787-844-5999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number6432
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: