Provider Demographics
NPI:1497763551
Name:DE JESUS GONZALEZ, EILYN (MD)
Entity Type:Individual
Prefix:DR
First Name:EILYN
Middle Name:
Last Name:DE JESUS GONZALEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:EILYN
Other - Middle Name:
Other - Last Name:DE JESUS GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:CONDOMINIO MURANO LUXURY APART
Mailing Address - Street 2:1. AVE PALMA REAL APT 1103
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-923-3749
Mailing Address - Fax:787-780-1163
Practice Address - Street 1:COND LOS ARCOS SUCHVILLE
Practice Address - Street 2:TORRE SUR 412
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966
Practice Address - Country:US
Practice Address - Phone:787-923-3749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13991207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine