Healthcare Provider Details

I. General information

NPI: 1780956375
Provider Name (Legal Business Name): MR. ANTONIO GONZALEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2012
Last Update Date: 01/18/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO PLAYITA C 71
SALINAS PR
00751
US

IV. Provider business mailing address

PO BOX 1218
GUAYAMA PR
00785-1218
US

V. Phone/Fax

Practice location:
  • Phone: 787-242-7551
  • Fax:
Mailing address:
  • Phone: 787-242-7551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WI0600X
TaxonomyInfection Control Registered Nurse
License Number2168E
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number32920
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number2168E
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: