Provider Demographics
NPI:1235172503
Name:NOEL GONZALEZ ORTIZ
Entity Type:Organization
Organization Name:NOEL GONZALEZ ORTIZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DUENO
Authorized Official - Prefix:
Authorized Official - First Name:NOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-825-1544
Mailing Address - Street 1:P O BOX 1146
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705
Mailing Address - Country:US
Mailing Address - Phone:787-825-1544
Mailing Address - Fax:787-825-1544
Practice Address - Street 1:PARCELAS NIAGARA 47
Practice Address - Street 2:
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769
Practice Address - Country:US
Practice Address - Phone:787-825-1544
Practice Address - Fax:787-825-1544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
0055251Medicare ID - Type Unspecified