Provider Demographics
NPI:1306816640
Name:GONZALEZ MESTRE, MAGALY (OD)
Entity Type:Individual
Prefix:
First Name:MAGALY
Middle Name:
Last Name:GONZALEZ MESTRE
Suffix:
Gender:F
Credentials:OD
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 1194
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685
Mailing Address - Country:US
Mailing Address - Phone:787-280-6986
Mailing Address - Fax:787-280-6988
Practice Address - Street 1:200 RUIZ BELVIS
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685
Practice Address - Country:US
Practice Address - Phone:787-280-6986
Practice Address - Fax:787-280-6988
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2013-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR502011152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U97001Medicare UPIN
PR56565Medicare ID - Type Unspecified