Provider Demographics
NPI:1447386461
Name:GONZALEZ, IRAIDA
Entity Type:Individual
Prefix:
First Name:IRAIDA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:#34 CAMINO LA RIBERAS 3-N 21 COLINAS DEL PLATA
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953
Mailing Address - Country:US
Mailing Address - Phone:787-524-5344
Mailing Address - Fax:
Practice Address - Street 1:AVE. LOMAS VERDES, EDIF, UNIV. PHOENIX
Practice Address - Street 2:CARRETERA 177,KM.2.0
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-272-4998
Practice Address - Fax:787-272-4969
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2951183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2951OtherPHARMACIST TECHNICIAN