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General NPI Number Information
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NPI Number | 1710238621
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Entity Type | Organization
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Legal Business Name | CENTRO DE MEDICINA COMPLEMENTARIA Y ALTERNATIVA
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Dates
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Enumeration Date | 10/02/2012
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Last Update Date | 10/02/2012
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Provider Practice Location Address
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Address Line | UNION ST # 83 GALERIAS PONCENAS
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City | PONCE
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State | PR
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Zip | 00731
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Country | US
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Telephone | 787-284-6261
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Fax | 787-284-6261
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Provider Business Mailing Address
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Address Line | PO BOX 334614
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City | PONCE
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State | PR
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Zip | 00733-4614
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Country | US
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Telephone | 787-202-6822
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANTONIO GONZALEZ
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Credential | MD
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Telephone | 787-202-6822
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 3316
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 777
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License Number State | PR
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