Provider Demographics
NPI:1508476631
Name:GONZALEZ HERNANDEZ, RAMON LUIS (PA)
Entity Type:Individual
Prefix:
First Name:RAMON
Middle Name:LUIS
Last Name:GONZALEZ HERNANDEZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:Q17 CALLE 10 SIERRA LINDA
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00957-2130
Mailing Address - Country:US
Mailing Address - Phone:787-922-7425
Mailing Address - Fax:
Practice Address - Street 1:Q17 CALLE 10 SIERRA LINDA
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957-2130
Practice Address - Country:US
Practice Address - Phone:787-922-7425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR138363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical