Provider Demographics
NPI:1639130297
Name:GONZALEZ, MELVA N (MD)
Entity Type:Individual
Prefix:DR
First Name:MELVA
Middle Name:N
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MELVA
Other - Middle Name:N
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 29430
Mailing Address - Street 2:
Mailing Address - City:RIO PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00929-0430
Mailing Address - Country:US
Mailing Address - Phone:787-768-4278
Mailing Address - Fax:787-769-2220
Practice Address - Street 1:820 AVE ITURREGUI
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-1723
Practice Address - Country:US
Practice Address - Phone:787-768-4278
Practice Address - Fax:787-769-2220
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13605207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR20397Medicare PIN