Provider Demographics
NPI:1376505586
Name:ALCANTARA GONZALEZ, ALTAGRACIA A (MD)
Entity Type:Individual
Prefix:DR
First Name:ALTAGRACIA
Middle Name:A
Last Name:ALCANTARA GONZALEZ
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:97 CALLE AZALEA
Mailing Address - Street 2:CIUDAD JARDIN I
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-4846
Mailing Address - Country:US
Mailing Address - Phone:787-787-0933
Mailing Address - Fax:787-778-0230
Practice Address - Street 1:TT14 CALLE 37
Practice Address - Street 2:SANTA JUANITA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-4741
Practice Address - Country:US
Practice Address - Phone:787-787-0933
Practice Address - Fax:787-778-0230
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR11898207RE0101X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR060669OtherCRUZ AZUL PIN NUMBER
PR9560059OtherHUMANA PIN NUMBER
PR88687OtherTRIPLE S PIN NUMBER
PR060669OtherCRUZ AZUL PIN NUMBER
PR0088687Medicare PIN