Provider Demographics
NPI:1235794942
Name:GONZALEZ CHEVEREZ, CARMEN HAYDEE
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:HAYDEE
Last Name:GONZALEZ CHEVEREZ
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 594
Mailing Address - Street 2:
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783-0594
Mailing Address - Country:US
Mailing Address - Phone:787-859-0200
Mailing Address - Fax:
Practice Address - Street 1:CARR 165 KM 13.9
Practice Address - Street 2:PUEBLO DESVIO NORTE KM 13.9
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783
Practice Address - Country:US
Practice Address - Phone:787-859-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR979225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist