Healthcare Provider Details

I. General information

NPI: 1982954707
Provider Name (Legal Business Name): MARISOL MILAGROS GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2012
Last Update Date: 09/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

759 AVE AVELINO VICENTE
SAN JUAN PR
00909-2615
US

IV. Provider business mailing address

URB OCEAN PARK 2007 CALLE ESPANA APT C
SAN JUAN PR
00911
US

V. Phone/Fax

Practice location:
  • Phone: 787-410-5443
  • Fax: 787-724-5559
Mailing address:
  • Phone: 732-216-7520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1131
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: