Provider Demographics
NPI:1568665008
Name:GONZALEZ ORTIZ, JAVIER (R PH)
Entity Type:Individual
Prefix:
First Name:JAVIER
Middle Name:
Last Name:GONZALEZ ORTIZ
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 SEVILLA
Mailing Address - Street 2:URB. VISTA ALEGRE
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-0000
Mailing Address - Country:US
Mailing Address - Phone:787-891-2748
Mailing Address - Fax:787-872-2145
Practice Address - Street 1:1-350 G NOEL ESTRADA
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-1127
Practice Address - Country:US
Practice Address - Phone:787-872-1930
Practice Address - Fax:787-872-2145
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4497183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist