Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 34137-R | PR |
NPI | 1003468935 |
---|---|
Provider Name | Paulina Gonzalez Carcache |
First Address | Guaynabo, PR 00969 |
Second Address | Ponce, PR 00717-1310 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2019 |
Last Update Date | 11/07/2019 |