Provider Demographics
NPI:1598755118
Name:GONZALEZ, JULIO A (MD)
Entity Type:Individual
Prefix:
First Name:JULIO
Middle Name:A
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1332
Mailing Address - Street 2:CALLE GANDARA 13 ALTOS
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783-7002
Mailing Address - Country:US
Mailing Address - Phone:787-859-5818
Mailing Address - Fax:787-859-3656
Practice Address - Street 1:CALLE GANDARA 13 ALTOS
Practice Address - Street 2:
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783-7002
Practice Address - Country:US
Practice Address - Phone:787-859-5818
Practice Address - Fax:787-859-3656
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8354207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E-63410Medicare ID - Type Unspecified
E63410Medicare UPIN