Provider Demographics
NPI:1033180179
Name:GONZALEZ, MARIA IVETTE (MD)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:IVETTE
Last Name:GONZALEZ
Suffix:
Gender:F
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 250144
Mailing Address - Street 2:RAMEY
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00604-0144
Mailing Address - Country:US
Mailing Address - Phone:787-894-3226
Mailing Address - Fax:787-650-7304
Practice Address - Street 1:179 CALLE SAN RAFAEL
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-5877
Practice Address - Country:US
Practice Address - Phone:787-894-3226
Practice Address - Fax:787-650-7304
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4225170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRD95839Medicare UPIN