Healthcare Provider Details

I. General information

NPI: 1386686921
Provider Name (Legal Business Name): GONASA CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 694 KM 1.2 SECTOR MONTE REY BO ESPINOSA
VEGA ALTA PR
00692
US

IV. Provider business mailing address

HC 83 BOX 6204 SECTOR MONTE REY
VEGA ALTA PR
00692-9706
US

V. Phone/Fax

Practice location:
  • Phone: 787-270-1816
  • Fax: 787-270-2593
Mailing address:
  • Phone: 787-883-2913
  • Fax: 787-270-2593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number17F2233
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DAMARIS MARILIA RUIZ RIVERA
Title or Position: PIC/OWNER
Credential: R.PH.
Phone: 787-883-2913