Provider Demographics
NPI:1629841382
Name:GOMEZ-CONSUEGRA, JOSSAN RENE (PA)
Entity Type:Individual
Prefix:DR
First Name:JOSSAN
Middle Name:RENE
Last Name:GOMEZ-CONSUEGRA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 AVE ESMERALDA
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-4430
Mailing Address - Country:US
Mailing Address - Phone:787-287-2690
Mailing Address - Fax:
Practice Address - Street 1:15 AVE ESMERALDA
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-4430
Practice Address - Country:US
Practice Address - Phone:787-287-2690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1611363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical