Healthcare Provider Details

I. General information

NPI: 1821006503
Provider Name (Legal Business Name): ROBERT A GONZALEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 05/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CENTRO CARDIOVASCULAR DE PR Y EL CARIBE SUITE #8A
RIO PIEDRAS PR
00936
US

IV. Provider business mailing address

PO BOX 70344 PMB 331
SAN JUAN PR
00936
US

V. Phone/Fax

Practice location:
  • Phone: 787-767-0619
  • Fax: 787-767-4127
Mailing address:
  • Phone: 787-767-0619
  • Fax: 787-767-4127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number8069
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number8069
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: