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General NPI Number Information
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NPI Number | 1740483296
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Entity Type | Individual
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Provider Name | JENNIFFER MARIE GONZALEZ M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/11/2007
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Last Update Date | 10/15/2012
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Provider Practice Location Address
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Address Line | COND. AQUABLUE 48 AVE. MUNOZ RIVERA APT. 1607
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City | SAN JUAN
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State | PR
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Zip | 00918
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Country | US
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Telephone | 787-648-8548
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Fax |
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Provider Business Mailing Address
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Address Line | 48 AVE MUNOZ RIVERA APT 1607 COND AQUABLUE
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City | SAN JUAN
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State | PR
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Zip | 00918
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Country | US
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Telephone | 787-648-8548
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 17563
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License Number State | PR
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