Provider Demographics
NPI:1760700801
Name:GONZALEZ, JOSE G (TEM, RN)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:G
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:TEM, RN
Other - Prefix:MR
Other - First Name:JOSE
Other - Middle Name:G
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:TEM, RN
Mailing Address - Street 1:CARR 420 KM 4.0 INT BO PLATA
Mailing Address - Street 2:HC-04 BOX 13942
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676
Mailing Address - Country:US
Mailing Address - Phone:787-218-7890
Mailing Address - Fax:
Practice Address - Street 1:CARR 420 KM 4.0 INT BO PLATA
Practice Address - Street 2:HC-04 BOX 13942
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676
Practice Address - Country:US
Practice Address - Phone:787-218-7890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2267-P146L00000X
PR14089P163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
No163W00000XNursing Service ProvidersRegistered Nurse