Provider Demographics
NPI:1528014271
Name:GONZALEZ RODRIGUEZ, NESTOR M (MD)
Entity Type:Individual
Prefix:DR
First Name:NESTOR
Middle Name:M
Last Name:GONZALEZ RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:NESTOR
Other - Middle Name:M
Other - Last Name:GONZALEZ RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PLAZA RIO HONDO
Mailing Address - Street 2:LOCAL 3 R SUITE 201
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-3106
Mailing Address - Country:US
Mailing Address - Phone:787-784-5899
Mailing Address - Fax:787-784-5899
Practice Address - Street 1:PLAZA RIO HONDO
Practice Address - Street 2:LOCAL 3 R SUITE 201
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-3106
Practice Address - Country:US
Practice Address - Phone:787-784-5899
Practice Address - Fax:787-784-5899
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8884207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE81689Medicare UPIN