Healthcare Provider Details

I. General information

NPI: 1235672460
Provider Name (Legal Business Name): GIOVANNI A GONZALEZ ALBO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2016
Last Update Date: 07/20/2023
Certification Date: 07/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2213 PONCE BYP
PONCE PR
00717-1310
US

IV. Provider business mailing address

PO BOX 7825
PONCE PR
00732-7825
US

V. Phone/Fax

Practice location:
  • Phone: 787-840-8686
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberME142091
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number21596
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: