Provider Demographics
NPI:1679575310
Name:GONZALEZ, ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8787
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00988-8787
Mailing Address - Country:US
Mailing Address - Phone:787-762-4132
Mailing Address - Fax:
Practice Address - Street 1:4ES5 VIA LETICIA
Practice Address - Street 2:VILLA FONTANA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983-4807
Practice Address - Country:US
Practice Address - Phone:787-762-4132
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5985170100000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics
Not Answered174400000XOther Service ProvidersSpecialist