Provider Demographics
NPI:1710962717
Name:GOTOS, JUAN ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:ANTONIO
Last Name:GOTOS
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 1:3071 AVE ALEJANDRINO
Mailing Address - Street 2:SUITE 140
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-7035
Mailing Address - Country:US
Mailing Address - Phone:787-671-3373
Mailing Address - Fax:
Practice Address - Street 1:735 AVE PONCE DE LEON
Practice Address - Street 2:SUITE 703
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-5031
Practice Address - Country:US
Practice Address - Phone:787-751-1878
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5401174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist