Provider Demographics
NPI:1093932071
Name:GONZALEZ-SALA, ROBERTO L (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:L
Last Name:GONZALEZ-SALA
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 1754
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-1754
Mailing Address - Country:US
Mailing Address - Phone:787-746-1688
Mailing Address - Fax:787-746-2292
Practice Address - Street 1:50 AVE L MUNOZ MARIN
Practice Address - Street 2:QUADRANGLE MEDICAL CENTER, SUITE 208
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-3975
Practice Address - Country:US
Practice Address - Phone:787-746-1688
Practice Address - Fax:787-746-2292
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR82362085R0202X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR29872OtherMEDICARE
PRM6869OtherCRUZ AZUL DE PR PROVIDER
PRM6869OtherCRUZ AZUL DE PR PROVIDER