Healthcare Provider Details

I. General information

NPI: 1255078457
Provider Name (Legal Business Name): GUILLERMO JOSE GONZALEZ FIGUEROA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2022
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 AVE TITO CASTRO
PONCE PR
00716-4717
US

IV. Provider business mailing address

PO BOX 993
ADJUNTAS PR
00601-0993
US

V. Phone/Fax

Practice location:
  • Phone: 787-844-2080
  • Fax:
Mailing address:
  • Phone: 787-669-4215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number24675
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: