Healthcare Provider Details

I. General information

NPI: 1679666739
Provider Name (Legal Business Name): GERMAN LUIS GONZALEZ GONZALEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 06/08/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA # 2 KM 174.0 SAN GERMAN MEDICAL PLAZA SUITE 202
SAN GERMAN PR
00683-1905
US

IV. Provider business mailing address

PO BOX 923
HORMIGUEROS PR
00660-0923
US

V. Phone/Fax

Practice location:
  • Phone: 787-264-2124
  • Fax:
Mailing address:
  • Phone: 787-264-2124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number16660
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: