Provider Demographics
NPI:1104011832
Name:DR. LEONARDO VALENTIN GONZALEZ, P.S.C.
Entity Type:Organization
Organization Name:DR. LEONARDO VALENTIN GONZALEZ, P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARDO
Authorized Official - Middle Name:I
Authorized Official - Last Name:VALENTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-740-8787
Mailing Address - Street 1:PO BOX 8973
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960
Mailing Address - Country:US
Mailing Address - Phone:787-740-8787
Mailing Address - Fax:787-884-0510
Practice Address - Street 1:STREET NO 2 NO 46
Practice Address - Street 2:PROFESSIONAL HOSPITAL
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-884-0505
Practice Address - Fax:787-884-0510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8183302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRA12226Medicare UPIN