Provider Demographics
NPI:1376678870
Name:GONZALEZ-GONZALEZ, BERNARDO A (MD)
Entity Type:Individual
Prefix:DR
First Name:BERNARDO
Middle Name:A
Last Name:GONZALEZ-GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1729
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00694-1729
Mailing Address - Country:US
Mailing Address - Phone:787-854-1357
Mailing Address - Fax:787-854-1357
Practice Address - Street 1:MARGINAL B10
Practice Address - Street 2:FLAMBOYAN
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-854-1357
Practice Address - Fax:787-854-1357
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR10825208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR10825OtherMEDICAL LICENSE