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General NPI Number Information
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NPI Number | 1992982334
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Entity Type | Individual
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Provider Name | LUDGARDO FERMIN GONZALEZ MARIN SR. MD
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Gender | Male
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Dates
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Enumeration Date | 01/29/2008
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Last Update Date | 01/29/2008
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Provider Practice Location Address
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Address Line | 51-46 MAIN AVENUE URBANIZACION SANTA ROSA 2DO PISO
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City | BAYAMON
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State | PR
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Zip | 00959
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Country | US
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Telephone | 787-585-5518
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Fax | 787-798-5275
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Provider Business Mailing Address
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Address Line | 290 SANTA ANA AVENUE BUZON 39 TORRIMAR TOWN PARK APTO B-203
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City | GUAYNABO
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State | PR
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Zip | 00969-3361
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Country | US
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Telephone | 787-585-5518
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Fax | 787-790-1304
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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 | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 5062PUERTORICO
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License Number State | PR
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