Provider Demographics
NPI:1801816491
Name:LLADO GONZALEZ, IVAN JOSE (MD)
Entity Type:Individual
Prefix:DR
First Name:IVAN
Middle Name:JOSE
Last Name:LLADO GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 6480
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-5480
Mailing Address - Country:US
Mailing Address - Phone:787-798-6550
Mailing Address - Fax:787-798-6590
Practice Address - Street 1:CALLE SANTA CRUZ # 66
Practice Address - Street 2:INSTITUTO SAN PABLO STE.#202
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00659
Practice Address - Country:US
Practice Address - Phone:787-798-6550
Practice Address - Fax:787-798-6590
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR6495207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRD-32370Medicare UPIN
PR29155BMedicare PIN