Provider Demographics
NPI:1578833935
Name:GONZALEZ BIANCHI, EDGARDO (MT)
Entity Type:Individual
Prefix:MR
First Name:EDGARDO
Middle Name:
Last Name:GONZALEZ BIANCHI
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:DBA
Other - Middle Name:LABORATORIO
Other - Last Name:CLINICO TORRECILLAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:20 VISTA DEL VALLE
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-4970
Mailing Address - Country:US
Mailing Address - Phone:787-390-5834
Mailing Address - Fax:
Practice Address - Street 1:CARR 155 KM 51.2
Practice Address - Street 2:
Practice Address - City:MOROVIS
Practice Address - State:PR
Practice Address - Zip Code:00687
Practice Address - Country:US
Practice Address - Phone:787-390-5834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-03
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRCO3287246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist