Provider Demographics
NPI:1780218073
Name:GONZALEZ, CRISTINA B (OPT)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:B
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:OPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 8 BOX 68920
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-6125
Mailing Address - Country:US
Mailing Address - Phone:787-820-3322
Mailing Address - Fax:
Practice Address - Street 1:CARR 2 KM 87.7 ESQUINA CARR 130 BO PUEBLO
Practice Address - Street 2:LA CEIBA SHOPPING VILLAGE SUITE 5
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659
Practice Address - Country:US
Practice Address - Phone:787-820-3322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1315156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician