Provider Demographics
NPI:1932318391
Name:GONZALEZ, OLGA MARIA (LND)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:MARIA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LND
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 344
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-0344
Mailing Address - Country:US
Mailing Address - Phone:787-473-1666
Mailing Address - Fax:787-891-2173
Practice Address - Street 1:EDIFICIO TAVAREZ
Practice Address - Street 2:CALLE JESUS T. PINEIRO # 7
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-0344
Practice Address - Country:US
Practice Address - Phone:787-717-4195
Practice Address - Fax:787-891-2173
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1275133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist