Healthcare Provider Details

I. General information

NPI: 1346286408
Provider Name (Legal Business Name): NANETTE L GONZALEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 CALLE SAN JORGE SUITE 406 SAN JORGE MEDICAL OFFICE
SAN JUAN PR
00912-3310
US

IV. Provider business mailing address

URB LAS VEREDAS 169 LAS VEREDAS DE LAS PALMAS
GURABO PR
00778-9680
US

V. Phone/Fax

Practice location:
  • Phone: 787-726-0210
  • Fax: 787-728-5136
Mailing address:
  • Phone: 787-616-7287
  • Fax: 787-728-5136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number13443
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: