Healthcare Provider Details

I. General information

NPI: 1275654790
Provider Name (Legal Business Name): GONZALEZ & SANTIAGO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 04/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 CALLE MUNOZ RIVERA
VILLALBA PR
00766-3034
US

IV. Provider business mailing address

152 JOSE RODRIGUEZ IRIZARRY STE 101
ARECIBO PR
00612
US

V. Phone/Fax

Practice location:
  • Phone: 787-847-3045
  • Fax: 787-847-3785
Mailing address:
  • Phone: 787-879-4744
  • Fax: 787-879-4744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number18-F-3375
License Number StatePR

VIII. Authorized Official

Name: VIVIAN BATISTA
Title or Position: ADMINISTRADORA
Credential:
Phone: 787-879-4744