Healthcare Provider Details

I. General information

NPI: 1750360681
Provider Name (Legal Business Name): CARMEN I GONZALEZ-KEELAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 12/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PATOLOGIA RCM - UPR APARTADO 29134
SAN JUAN PR
00929-0134
US

IV. Provider business mailing address

PO BOX 365067 DEPARTAMENTO DE PATOLOGIA RCM
SAN JUAN PR
00936-5067
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-2525
  • Fax: 787-754-0710
Mailing address:
  • Phone: 787-758-2525
  • Fax: 787-754-0710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number6705
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: