Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 6432 | PR |
NPI | 1275591489 |
---|---|
Provider Name | Dr. Roberto Gonzalez Gonzalez |
First Address | Ponce, PR 00732-7214 |
Second Address | Ponce, PR 00717-1689 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 21/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D26703 | (02) | PR |