Provider Demographics
NPI:1013024587
Name:MUNOZ GONZALEZ, ELIASIN (MD)
Entity Type:Individual
Prefix:
First Name:ELIASIN
Middle Name:
Last Name:MUNOZ GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 472
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-0472
Mailing Address - Country:US
Mailing Address - Phone:787-690-2157
Mailing Address - Fax:787-833-3831
Practice Address - Street 1:351 AVE HOSTOS
Practice Address - Street 2:MEDICAL EMPORIUM I SUITE 205
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-1509
Practice Address - Country:US
Practice Address - Phone:787-831-5831
Practice Address - Fax:787-827-8020
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9121207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE33355Medicare UPIN