Healthcare Provider Details

I. General information

NPI: 1902223845
Provider Name (Legal Business Name): MRS. ANGELA IVETTE GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2014
Last Update Date: 03/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

759 AVE AVELINO VICENTE
SAN JUAN PR
00909-2538
US

IV. Provider business mailing address

128 CALLE ENSUENO MANSIONES MONTE VERDE
CAYEY PR
00736-4152
US

V. Phone/Fax

Practice location:
  • Phone: 787-410-5443
  • Fax: 787-724-5559
Mailing address:
  • Phone: 787-406-8793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number374
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: