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General NPI Number Information
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NPI Number | 1720070055
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Entity Type | Individual
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Provider Name | CARLOS M GONZALEZ MD
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Gender | Male
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Dates
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Enumeration Date | 08/23/2005
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Last Update Date | 07/25/2022
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Provider Practice Location Address
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Address Line | CALLE 24 BLOQ. 11 #18 VILLA CAROLINA
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City | CAROLINA
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State | PR
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Zip | 00985
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Country | US
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Telephone | 787-757-7030
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Fax | 787-757-7030
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Provider Business Mailing Address
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Address Line | URB CIUDAD JARDIN APARTADO 265 A63 CALLE SIEMPREVIVA
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City | CANOVANAS
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State | PR
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Zip | 00729-0265
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Country | US
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Telephone | 787-757-7030
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Fax | 787-757-7030
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 5773
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License Number State | PR
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