Provider Demographics
NPI:1922203199
Name:DAVIS-GONZALEZ, CARLOS H (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:H
Last Name:DAVIS-GONZALEZ
Suffix:
Gender:M
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:PO BOX 364254
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-4254
Mailing Address - Country:US
Mailing Address - Phone:787-761-2748
Mailing Address - Fax:
Practice Address - Street 1:3 CALLE SEGUNDO DIAZ
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:PR
Practice Address - Zip Code:00751-3329
Practice Address - Country:US
Practice Address - Phone:787-824-7058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11563208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR11563Other# LIC