Provider Demographics
NPI:1851572184
Name:GONZALEZ, MARIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIAN
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. SAN JOSE #621
Mailing Address - Street 2:CARMELO SEGLAR ST.
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728-1909
Mailing Address - Country:US
Mailing Address - Phone:787-843-1492
Mailing Address - Fax:
Practice Address - Street 1:URB. SAN JOSE #621
Practice Address - Street 2:CARMELO SEGLAR ST.
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728-1909
Practice Address - Country:US
Practice Address - Phone:787-843-1492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16789208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice