Provider Demographics
NPI:1922219575
Name:GONZALEZ, ZENAIDA (LCDA)
Entity Type:Individual
Prefix:MRS
First Name:ZENAIDA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LCDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE BARBOSA 326
Mailing Address - Street 2:SECTOR CUBA, KM 5.2
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676
Mailing Address - Country:US
Mailing Address - Phone:787-818-2822
Mailing Address - Fax:787-818-2822
Practice Address - Street 1:CALLE BARBOSA
Practice Address - Street 2:SECTOR CUBA, KM 5.2
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676
Practice Address - Country:US
Practice Address - Phone:787-818-2822
Practice Address - Fax:787-818-2822
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1137291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory