Provider Demographics
NPI:1043430283
Name:GONZALEZ CASTRO, MELISSA MARIE (DC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARIE
Last Name:GONZALEZ CASTRO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 CALLE PEDRO ESPADA
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-2800
Mailing Address - Country:US
Mailing Address - Phone:787-306-5623
Mailing Address - Fax:
Practice Address - Street 1:403 CALLE PEDRO ESPADA
Practice Address - Street 2:SUITE 1
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-2800
Practice Address - Country:US
Practice Address - Phone:787-306-5623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-30
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR458111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor