Provider Demographics
NPI:1467585158
Name:GONZALEZ, ZOMAIRA (TO)
Entity Type:Individual
Prefix:
First Name:ZOMAIRA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:TO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE BALDORIOTY
Mailing Address - Street 2:#165 NORTE SUITE 5
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705
Mailing Address - Country:US
Mailing Address - Phone:787-735-1818
Mailing Address - Fax:787-991-2910
Practice Address - Street 1:CALLE BALDORIOTY
Practice Address - Street 2:#165 NORTE SUITE 5
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705
Practice Address - Country:US
Practice Address - Phone:787-735-1818
Practice Address - Fax:787-991-2910
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1059225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist