Provider Demographics
NPI:1053476507
Name:BOSCH-GONSALVEZ, ENRIQUE FRANCISCO (MD)
Entity Type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:FRANCISCO
Last Name:BOSCH-GONSALVEZ
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 9098
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-9098
Mailing Address - Country:US
Mailing Address - Phone:787-786-9008
Mailing Address - Fax:
Practice Address - Street 1:66 CALLE SANTA CRUZ
Practice Address - Street 2:INST. SAN PABLO SUITE 410
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-7041
Practice Address - Country:US
Practice Address - Phone:787-786-9008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6332208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6332OtherSTATE LICENSE NUMBER