Provider Demographics
NPI:1568590693
Name:GONZALEZ, BLANCA ENID (PHD)
Entity Type:Individual
Prefix:
First Name:BLANCA
Middle Name:ENID
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CANDINA STREET
Mailing Address - Street 2:COND.CANDINA REEF 802
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907
Mailing Address - Country:US
Mailing Address - Phone:787-722-1740
Mailing Address - Fax:787-722-1740
Practice Address - Street 1:CANDINA STREET
Practice Address - Street 2:COND.CANDINA REEF 802
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907
Practice Address - Country:US
Practice Address - Phone:787-722-1740
Practice Address - Fax:787-721-5349
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2169183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2169OtherPHARMACIST