Healthcare Provider Details

I. General information

NPI: 1326913682
Provider Name (Legal Business Name): JONATHAN GONZALEZ-BARRETO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2025
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 111 INT. 602 KM 1.8 BO. ANGELES, SECTOR ALTURAS
UTUADO PR
00641-1696
US

IV. Provider business mailing address

PO BOX 1696
UTUADO PR
00641-1696
US

V. Phone/Fax

Practice location:
  • Phone: 939-237-8789
  • Fax:
Mailing address:
  • Phone: 939-237-8789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number24706
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: