Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 13602 | PR |
NPI | 1043230428 |
---|---|
Provider Name | Dr. Larry Bernier Gonzalez |
First Address | Ponce, PR 00717 |
Second Address | Arroyo, PR 00714 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 08/07/2007 |