Provider Demographics
NPI:1184189334
Name:GONZALEZ ORTIZ, FABIOLA
Entity Type:Individual
Prefix:
First Name:FABIOLA
Middle Name:
Last Name:GONZALEZ ORTIZ
Suffix:
Gender:F
Credentials:
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 357
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-0357
Mailing Address - Country:US
Mailing Address - Phone:787-547-4646
Mailing Address - Fax:
Practice Address - Street 1:BO. MOLINAS CARR 365 KM 3.4 INT
Practice Address - Street 2:
Practice Address - City:SABAN GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00637-2600
Practice Address - Country:US
Practice Address - Phone:787-892-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-01
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23535208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty