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General NPI Number Information
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NPI Number | 1659493799
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Entity Type | Individual
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Provider Name | CARLOS J. GONZALEZ DEGRO MD
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Gender | Male
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 06/24/2019
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Provider Practice Location Address
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Address Line | LA FUENTE TOWNCENTER SUITE 11,119
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City | GUAYAMA
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State | PR
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Zip | 00784-9998
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Country | US
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Telephone | 787-866-4455
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Fax | 787-866-1733
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Provider Business Mailing Address
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Address Line | PMB 362 AVE. TITO CASTRO 609 STE 102
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City | PONCE
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State | PR
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Zip | 00716-0200
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Country | US
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Telephone | 787-866-4455
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Fax | 787-866-1733
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 012000
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License Number State | PR
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