Provider Demographics
NPI:1154470045
Name:GONZALEZ, SEMIRAMIS (DMD,MSD,MPH)
Entity Type:Individual
Prefix:DR
First Name:SEMIRAMIS
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:DMD,MSD,MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 LAS CUMBRES AVE
Mailing Address - Street 2:APT. PH 2608
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-0000
Mailing Address - Country:US
Mailing Address - Phone:787-292-0602
Mailing Address - Fax:
Practice Address - Street 1:340 FELISA RINCON DE GAUTIER AVE
Practice Address - Street 2:APT. PH 2608
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-0000
Practice Address - Country:US
Practice Address - Phone:787-292-0602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR591122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist