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NPI Code Detail

MEDICARE: BETHEL MARIE GONZALEZ MD

MEDICARE: BETHEL MARIE GONZALEZ MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker16595PR

General Provider Information

NPI Number : 1104608827
Entity Type Code : Individual
Provider Name (Legal Business Name) : BETHEL MARIE GONZALEZ MD
Provider Business Mailing Address
First Line : RR 7 BOX 6710
Second Line :
City : SAN JUAN
State : PR
Zip : 00926-9121
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : TURABO GARDENS CARR.172 SALIDA 21
Second Line : TURABO GARDENS CARR.172 SALIDA 21
City : CAGUAS
State : PR
Zip : 00727-7084
Country : US
Telephone Number : 787-653-0550
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2023
Last Update Date : 10/17/2023

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