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General NPI Number Information
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NPI Number | 1811482029
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Entity Type | Individual
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Provider Name | ENID M. GONZALEZ RD
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Gender | Female
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Dates
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Enumeration Date | 06/29/2018
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Last Update Date | 06/29/2018
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Provider Practice Location Address
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Address Line | CALLE DE DIEGO 369 TORRE SAN FRANCISCO SUITE 507
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City | SAN JUAN
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State | PR
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Zip | 00923
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Country | US
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Telephone | 787-282-3000
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Fax | 787-282-3080
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Provider Business Mailing Address
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Address Line | 8 PLAZA SANTA CRUZ
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City | TRUJILLO ALTO
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State | PR
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Zip | 00976-6123
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Country | US
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Telephone | 787-760-6000
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Fax | 787-282-3080
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 832272
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License Number State | PR
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