Provider Demographics
NPI:1437824182
Name:GONZALEZ BRAVO, ANGEL ENRIQUE (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:ENRIQUE
Last Name:GONZALEZ BRAVO
Suffix:
Gender:M
Credentials:PHARMD
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 141574
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-1574
Mailing Address - Country:US
Mailing Address - Phone:787-597-2001
Mailing Address - Fax:
Practice Address - Street 1:B3 CALLE 27
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-2874
Practice Address - Country:US
Practice Address - Phone:787-597-2001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-14
Last Update Date:2021-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS61566183500000X
PR6792183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist