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General NPI Number Information
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NPI Number | 1063914729
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Entity Type | Organization
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Legal Business Name | SAN LAZARGERD MEDICAL II CSP
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Dates
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Enumeration Date | 03/08/2018
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Last Update Date | 03/08/2018
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Provider Practice Location Address
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Address Line | CARR 129 KM 21.2 BO CALLEJONES
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City | LARES
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State | PR
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Zip | 00669
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Country | US
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Telephone | 787-897-0353
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 428
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City | LARES
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State | PR
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Zip | 00669-0428
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Country | US
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Telephone | 787-897-0353
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | GERALDO GONZALEZ
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Credential | MD
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Telephone | 787-897-0560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number |
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 2471S1302X
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Taxonomy Name | Sonography Radiologic Technologist
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License Number |
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License Number State | PR
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Taxonomy #3
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Taxonomy Code | 2471V0105X
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Taxonomy Name | Vascular Sonography Radiologic Technologist
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License Number |
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License Number State | PR
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Taxonomy #4
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State | PR
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