Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | 5402 | PR |
NPI | 1659468478 |
---|---|
Provider Name | Dr. Angel A Gonzalez-Carrasquillo |
First Address | Guaynabo, PR 00971-8000 |
Second Address | Guaynabo, PR 00971-8000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C79570 | (02) | PR |