Provider Demographics
NPI:1396039012
Name:GONZALEZ, MARIA DEL CARMEN (RPH)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:DEL CARMEN
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 AVE FELISA R DE GAUTIER
Mailing Address - Street 2:COND COLINA REAL BOX 1508
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6496
Mailing Address - Country:US
Mailing Address - Phone:787-646-0737
Mailing Address - Fax:
Practice Address - Street 1:GALERIA PASEOS
Practice Address - Street 2:100 BOULEVARD PASEOS
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00926-5905
Practice Address - Country:US
Practice Address - Phone:787-283-2555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-31
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3632183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist