Provider Demographics
NPI:1043349509
Name:DE JESUS GONZALEZ, MIRELLA
Entity Type:Individual
Prefix:MISS
First Name:MIRELLA
Middle Name:
Last Name:DE JESUS GONZALEZ
Suffix:
Gender:F
Credentials:
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 819
Mailing Address - Street 2:
Mailing Address - City:JAYUYA
Mailing Address - State:PR
Mailing Address - Zip Code:00664-0819
Mailing Address - Country:US
Mailing Address - Phone:787-828-0613
Mailing Address - Fax:787-828-0613
Practice Address - Street 1:CARRETERA 144 KM 2.8
Practice Address - Street 2:
Practice Address - City:JAYUYA
Practice Address - State:PR
Practice Address - Zip Code:00664
Practice Address - Country:US
Practice Address - Phone:787-828-0613
Practice Address - Fax:787-828-0613
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport