Provider Demographics
NPI:1821555715
Name:GONZALEZ PEREZ, CARLOS
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:GONZALEZ PEREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MED
Other - Middle Name:
Other - Last Name:CIT TRANSPORT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:HC 5 BOX 56769
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-5842
Mailing Address - Country:US
Mailing Address - Phone:787-597-4638
Mailing Address - Fax:
Practice Address - Street 1:BO POZAS SECTOR LOS NOBLES
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685
Practice Address - Country:US
Practice Address - Phone:787-454-7731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR9262OtherSSS