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General NPI Number Information
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NPI Number | 1992024848
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Entity Type | Individual
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Provider Name | MICHELLE GONZALEZ M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/18/2010
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Last Update Date | 04/26/2022
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Provider Practice Location Address
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Address Line | 1540 SPRING VALLEY DRIVE
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City | HUNTINGTON
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State | WV
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Zip | 25704-9501
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Country | US
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Telephone | 787-593-4475
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Fax | 304-429-7555
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Provider Business Mailing Address
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Address Line | 1540 SPRING VALLEY DRIVE
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City | HUNTINGTON
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State | WV
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Zip | 25704-9501
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Country | US
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Telephone | 787-593-4475
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Fax | 304-429-7555
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 17997
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License Number State | PR
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