Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 170100000X | Medical Geneticist | 5985 | PR |
NPI | 1679575310 |
---|---|
Provider Name | Dr. Antonio Gonzalez |
First Address | Carolina, PR 00988-8787 |
Second Address | Carolina, PR 00983-4807 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2005 |
Last Update Date | 08/07/2007 |