Provider Demographics
NPI:1508939968
Name:GONZALEZ, ERIS MABEL
Entity Type:Individual
Prefix:MRS
First Name:ERIS
Middle Name:MABEL
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 1:13 CALLE ANGELA FERRER
Mailing Address - Street 2:BO. COQUI
Mailing Address - City:AGUIRRE
Mailing Address - State:PR
Mailing Address - Zip Code:00704-2410
Mailing Address - Country:US
Mailing Address - Phone:787-824-5355
Mailing Address - Fax:787-824-1252
Practice Address - Street 1:31 CALLE J
Practice Address - Street 2:BO. PLAYA
Practice Address - City:SALINAS
Practice Address - State:PR
Practice Address - Zip Code:00751-2869
Practice Address - Country:US
Practice Address - Phone:787-824-5355
Practice Address - Fax:787-824-1252
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5159183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician