Provider Demographics
NPI:1376674994
Name:GONZALEZ, ANGEL LUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:LUIS
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:394 CALLE VALENCIA
Mailing Address - Street 2:MANS.CIUDAD JARDIN BAIROA
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-1413
Mailing Address - Country:US
Mailing Address - Phone:787-469-7201
Mailing Address - Fax:
Practice Address - Street 1:394 CALLE VALENCIA
Practice Address - Street 2:MANS.CIUDAD JARDIN BAIROA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727-1413
Practice Address - Country:US
Practice Address - Phone:787-469-7201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11598174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist