Provider Demographics
NPI:1619187119
Name:GONZALEZ, CARMEN M (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:M
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 71 BOX 4406
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736-9541
Mailing Address - Country:US
Mailing Address - Phone:787-738-6700
Mailing Address - Fax:
Practice Address - Street 1:HC 71 BOX 4406
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-9541
Practice Address - Country:US
Practice Address - Phone:787-309-9610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3603183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist