Provider Demographics
NPI:1164938692
Name:GONZALEZ, MARIA LOURDES (LAC)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:LOURDES
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 CALLE 1
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-4151
Mailing Address - Country:US
Mailing Address - Phone:787-894-1414
Mailing Address - Fax:
Practice Address - Street 1:PROFESSIONAL PLAZA
Practice Address - Street 2:CARR 2 KM 118.9 CAIMITAL ALTO
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-894-1414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-20
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2134171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist