Provider Demographics
NPI:1588824999
Name:GONZALEZ, YESIMAR III
Entity Type:Individual
Prefix:
First Name:YESIMAR
Middle Name:
Last Name:GONZALEZ
Suffix:III
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 1:250D CALLE 30
Mailing Address - Street 2:PARCELAS FALU
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-3133
Mailing Address - Country:US
Mailing Address - Phone:787-758-2000
Mailing Address - Fax:
Practice Address - Street 1:250D CALLE 30
Practice Address - Street 2:PARCELAS FALU
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-3133
Practice Address - Country:US
Practice Address - Phone:787-758-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5161183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician