MEDICARE: DR. ANTONIO GONZALEZ M.D.

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	170100000X	Ph.D. Medical Genetics	5985	PR
2	174400000X	Specialist	5985	PR

General Provider Information

NPI Number	:	1679575310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTONIO GONZALEZ M.D.

Provider Business Mailing Address
First Line	:	PO BOX 8787
Second Line	:
City	:	CAROLINA
State	:	PR
Zip	:	00988-8787
Country	:	US
Telephone Number	:	787-762-4132
Fax Number	:

Provider Business Practice Location Address
First Line	:	4ES5 VIA LETICIA
Second Line	:	VILLA FONTANA
City	:	CAROLINA
State	:	PR
Zip	:	00983-4807
Country	:	US
Telephone Number	:	787-762-4132
Fax Number	:

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

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	09/11/2025

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