Provider Demographics
NPI:1114449022
Name:GONZALEZ, JAVIER ALEJANDRO SR (MD)
Entity Type:Individual
Prefix:
First Name:JAVIER
Middle Name:ALEJANDRO
Last Name:GONZALEZ
Suffix:SR
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 9206
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-9206
Mailing Address - Country:US
Mailing Address - Phone:787-454-4408
Mailing Address - Fax:
Practice Address - Street 1:CENTRO MEDICO BO MONACILLOS
Practice Address - Street 2:1050 CARR 22
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927
Practice Address - Country:US
Practice Address - Phone:787-763-4149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-12
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22156208D00000X
PR14367-I208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice