Provider Demographics
NPI:1689712697
Name:GONZALEZ, RUTH O (RD)
Entity Type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:O
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:RD
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 953
Mailing Address - Street 2:SUITE5000
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-0953
Mailing Address - Country:US
Mailing Address - Phone:787-895-4883
Mailing Address - Fax:
Practice Address - Street 1:CENTRO COOP
Practice Address - Street 2:SUITE2
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-0953
Practice Address - Country:US
Practice Address - Phone:787-895-4883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR832623133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1106OtherLND
PR832623OtherRD
PR1106OtherLND