Provider Demographics
NPI:1629016563
Name:GONZALEZ-GRAJALES, EFRAIN
Entity Type:Individual
Prefix:MR
First Name:EFRAIN
Middle Name:
Last Name:GONZALEZ-GRAJALES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 02 BOX 21953
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-0507
Mailing Address - Country:US
Mailing Address - Phone:787-460-9077
Mailing Address - Fax:787-252-1385
Practice Address - Street 1:CARR 125, KM 05 INT
Practice Address - Street 2:CAMINO CORDERO, BO. PALMAR
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-460-9077
Practice Address - Fax:787-252-1385
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRP10803416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR70521OtherPREFERRED MEDICARE CHOICE
PR0057229Medicare ID - Type Unspecified