Healthcare Provider Details

I. General information

NPI: 1104596931
Provider Name (Legal Business Name): SANDRA MARIE GONZALEZ NARVAEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2021
Last Update Date: 12/12/2022
Certification Date: 12/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BARRIO BARRERO CARRETERA 429 K.M. 1.8
RINCON PR
00677
US

IV. Provider business mailing address

HC 2 BOX 5568
RINCON PR
00677-9585
US

V. Phone/Fax

Practice location:
  • Phone: 939-488-4864
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number023063
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: