Provider Demographics
NPI:1043240252
Name:CARLOS GONZALEZ AQUINO MD PSC
Entity Type:Organization
Organization Name:CARLOS GONZALEZ AQUINO MD PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ-AQUINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-268-2300
Mailing Address - Street 1:PO BOX 362707
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-2707
Mailing Address - Country:US
Mailing Address - Phone:787-268-2300
Mailing Address - Fax:787-268-3055
Practice Address - Street 1:AVE SAN JORGE 252 SUITE 501
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00912
Practice Address - Country:US
Practice Address - Phone:787-268-2300
Practice Address - Fax:787-268-3055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9966174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty