Provider Demographics
NPI:1922388982
Name:GONZALEZ ASTACIO, GUSTAVO J (MD)
Entity Type:Individual
Prefix:
First Name:GUSTAVO
Middle Name:J
Last Name:GONZALEZ ASTACIO
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 1:40 COND CAGUAS TOWER APT 1103
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-5634
Mailing Address - Country:US
Mailing Address - Phone:787-308-2905
Mailing Address - Fax:
Practice Address - Street 1:40 COND CAGUAS TOWER APT 1103
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-5634
Practice Address - Country:US
Practice Address - Phone:787-308-2905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-23
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18759207RC0200X
NY271918207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty