Provider Demographics
NPI:1750456109
Name:GONZALEZ, IVETTE (OD)
Entity Type:Individual
Prefix:DR
First Name:IVETTE
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 AVE WINSTON CHURCHILL STE A
Mailing Address - Street 2:EL SENORIAL
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6012
Mailing Address - Country:US
Mailing Address - Phone:787-764-6589
Mailing Address - Fax:787-758-1981
Practice Address - Street 1:131 AVE WINSTON CHURCHILL STE A
Practice Address - Street 2:EL SENORIAL
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-6012
Practice Address - Country:US
Practice Address - Phone:787-764-6589
Practice Address - Fax:787-758-1981
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR474152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist