=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326121013
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ENID GONZALEZ-PAGAN O.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2006
-----------------------------------------------------
Last Update Date | 01/05/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15 65 DE INFANTERIA S
-----------------------------------------------------
City | LAJAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00667-2010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-899-1244
-----------------------------------------------------
Fax | 787-899-1244
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 141 CALLE ORQUIDEA URB. EL VALLE
-----------------------------------------------------
City | LAJAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00667-2516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-899-1244
-----------------------------------------------------
Fax | 787-899-1244
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 527
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------