Provider Demographics
NPI:1184180515
Name:BURGOS GONZALEZ, JOSE ALBERTO (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:ALBERTO
Last Name:BURGOS GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOSE
Other - Middle Name:ALBERTO
Other - Last Name:BURGOS GONZALEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD JOSE BURGOS
Mailing Address - Street 1:HC 02 BOX 7228
Mailing Address - Street 2:
Mailing Address - City:BARRANQUITAS
Mailing Address - State:PR
Mailing Address - Zip Code:00794
Mailing Address - Country:US
Mailing Address - Phone:939-881-0140
Mailing Address - Fax:
Practice Address - Street 1:BARRIO BARRANCAS SECTOR COLLAO
Practice Address - Street 2:
Practice Address - City:BARRANQUITAS
Practice Address - State:PR
Practice Address - Zip Code:00794
Practice Address - Country:US
Practice Address - Phone:939-881-0140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program