Provider Demographics
NPI:1639304983
Name:GONZALEZ, AMNERYS A
Entity Type:Individual
Prefix:DR
First Name:AMNERYS
Middle Name:A
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 475
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-0475
Mailing Address - Country:US
Mailing Address - Phone:787-516-4677
Mailing Address - Fax:787-877-2267
Practice Address - Street 1:CALLE CONCEPCION VERA AYALA
Practice Address - Street 2:531
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676-0475
Practice Address - Country:US
Practice Address - Phone:787-877-4730
Practice Address - Fax:787-877-4730
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-15
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17572208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice