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General NPI Number Information
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NPI Number | 1578833935
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Entity Type | Individual
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Provider Name | EDGARDO GONZALEZ BIANCHI MT
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Gender | Male
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Dates
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Enumeration Date | 01/03/2012
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Last Update Date | 02/12/2016
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Provider Practice Location Address
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Address Line | CARR 155 KM 51.2
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City | MOROVIS
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State | PR
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Zip | 00687
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Country | US
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Telephone | 787-390-5834
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Fax |
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Provider Business Mailing Address
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Address Line | 20 VISTA DEL VALLE
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City | MANATI
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State | PR
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Zip | 00674-4970
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Country | US
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Telephone | 787-390-5834
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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 | 246QM0706X
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Taxonomy Name | Medical Technologist
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License Number | CO3287
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License Number State | PR
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