MEDICARE: MRS. CARMEN C GONZALEZ RN MSN

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
1	163WA2000X	Administrator Registered Nurse	1230	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2233715	OTHER	PR	LICENCIA
2	25761	OTHER	PR	LICENCIA ENFERMERIA

General Provider Information

NPI Number	:	1558784793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CARMEN C GONZALEZ RN MSN

Provider Business Mailing Address
First Line	:	PASEO SAN PABLO 100 STE 204
Second Line	:	EDIFICIO ARTURO CADILLA
City	:	BAYAMON
State	:	PR
Zip	:	00961
Country	:	US
Telephone Number	:	787-740-2925
Fax Number	:	787-786-4667

Provider Business Practice Location Address
First Line	:	PASEO SAN PABLO 100 STE 204
Second Line	:	EDIFICIO ARTURO CADILLA
City	:	BAYAMON
State	:	PR
Zip	:	00961-9998
Country	:	US
Telephone Number	:	787-740-2925
Fax Number	:	787-786-4667

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2014
Last Update Date	:	01/23/2014

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