Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | MD165384 | OR |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 19036 | PR |
NPI | 1750512604 |
---|---|
Provider Name | Javier Gonzalez |
First Address | San Juan, PR 00907-1007 |
Second Address | San Juan, PR 00907-1007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2009 |
Last Update Date | 17/08/2015 |