Provider Demographics
NPI:1851965784
Name:GONZALEZ SANCHEZ, STEPHANIE M
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:M
Last Name:GONZALEZ SANCHEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 74 BOX 5189
Mailing Address - Street 2:
Mailing Address - City:NARANJITO
Mailing Address - State:PR
Mailing Address - Zip Code:00719-7460
Mailing Address - Country:US
Mailing Address - Phone:787-902-7870
Mailing Address - Fax:
Practice Address - Street 1:BO GUADIANA SECT HATITO CARR 826 K.M 1.0
Practice Address - Street 2:
Practice Address - City:NARANJITO
Practice Address - State:PR
Practice Address - Zip Code:00719
Practice Address - Country:US
Practice Address - Phone:787-902-7870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-15
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PR15881208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program