Provider Demographics
NPI:1265685549
Name:DR.PEDRO J. GONZALEZ PC
Entity Type:Organization
Organization Name:DR.PEDRO J. GONZALEZ PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:J
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:301-588-0440
Mailing Address - Street 1:8905 FAIRVIEW RD
Mailing Address - Street 2:STE.500
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4150
Mailing Address - Country:US
Mailing Address - Phone:301-588-0440
Mailing Address - Fax:
Practice Address - Street 1:8905 FAIRVIEW RD
Practice Address - Street 2:STE.500
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4150
Practice Address - Country:US
Practice Address - Phone:301-588-0440
Practice Address - Fax:301-588-0443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1187PT111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty