Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 14730 | PR |
NPI | 1013064500 |
---|---|
Provider Name | Dr. Joel Gonzalez |
First Address | San Juan, PR 00936-6794 |
Second Address | Santurce, PR 00907 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2007 |
Last Update Date | 07/03/2011 |