Provider Demographics
NPI:1659493799
Name:GONZALEZ DEGRO, CARLOS J (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:J
Last Name:GONZALEZ DEGRO
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PMB 362 AVE. TITO CASTRO 609
Mailing Address - Street 2:STE 102
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-0200
Mailing Address - Country:US
Mailing Address - Phone:787-866-4455
Mailing Address - Fax:787-866-1733
Practice Address - Street 1:LA FUENTE TOWNCENTER
Practice Address - Street 2:SUITE 11,119
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784-9998
Practice Address - Country:US
Practice Address - Phone:787-866-4455
Practice Address - Fax:787-866-1733
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2019-06-24
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Provider Licenses
StateLicense IDTaxonomies
PR0120002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry