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General NPI Number Information
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NPI Number | 1245377993
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Entity Type | Individual
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Provider Name | LISSY I GONZALEZ
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Gender | Female
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 33 CALLE MUNOZ RIVERA W
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City | RINCON
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State | PR
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Zip | 00677-2124
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Country | US
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Telephone | 787-823-2540
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Fax | 787-823-3183
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Provider Business Mailing Address
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Address Line | HC 57 BOX 11941
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City | AGUADA
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State | PR
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Zip | 00602-9857
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Country | US
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Telephone | 787-868-3512
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 4132
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License Number State | PR
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