Healthcare Provider Details

I. General information

NPI: 1376102764
Provider Name (Legal Business Name): ANIBAL ENRIQUE GONZALEZ ALVAREZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CONDOMINIO LA CIUDADELA, 1511 AV. JUAN PONCE DE LEON SUITE 3
SAN JUAN PR
00909
US

IV. Provider business mailing address

CONDOMINIO LA CIUDADELA, 1511 AV. JUAN PONCE DE LEON SUITE 3
SAN JUAN PR
00909
US

V. Phone/Fax

Practice location:
  • Phone: 787-339-2639
  • Fax:
Mailing address:
  • Phone: 787-339-2639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25091
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: