Healthcare Provider Details

I. General information

NPI: 1255607222
Provider Name (Legal Business Name): NOELANI GONZALEZ ORTIZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2012
Last Update Date: 07/14/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 AVE FD ROOSEVELT STE 409 TORRE DE PLAZA
SAN JUAN PR
00918-8081
US

IV. Provider business mailing address

120 AVE CARLOS CHARDON STE 133
SAN JUAN PR
00918-1721
US

V. Phone/Fax

Practice location:
  • Phone: 787-473-0073
  • Fax:
Mailing address:
  • Phone: 787-505-9160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number021269
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: