Provider Demographics
NPI:1740401967
Name:GONZALEZ, MARIELA S (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MARIELA
Middle Name:S
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COND. PLAZA REAL CAPARRA APT.210 CARR.#2 KM.187
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-1816
Mailing Address - Country:US
Mailing Address - Phone:787-622-8445
Mailing Address - Fax:787-622-8459
Practice Address - Street 1:187 CARR 2 APT 210
Practice Address - Street 2:CARR.#2 KM.187
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966-1816
Practice Address - Country:US
Practice Address - Phone:787-622-8445
Practice Address - Fax:787-622-8459
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4239183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist