Healthcare Provider Details

I. General information

NPI: 1679554455
Provider Name (Legal Business Name): MARIBEL GONZALEZ M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 09/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1488 AVE EMERITO ESTRADA RIVERA
SAN SEBASTIAN PR
00685-3023
US

IV. Provider business mailing address

PO BOX 2003
SAN SEBASTIAN PR
00685-8003
US

V. Phone/Fax

Practice location:
  • Phone: 787-896-1076
  • Fax: 787-896-1076
Mailing address:
  • Phone: 787-896-1076
  • Fax: 787-896-1076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number3565
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: