Provider Demographics
NPI:1942362074
Name:GONZALEZ, MARIA DE LOURDES (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:DE LOURDES
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:110 CALLE VISTA HERMOSA
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-3359
Mailing Address - Country:US
Mailing Address - Phone:787-479-7522
Mailing Address - Fax:787-830-1654
Practice Address - Street 1:AVE AGUSTIN RAMOS CALERO
Practice Address - Street 2:KM 1.4
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662
Practice Address - Country:US
Practice Address - Phone:787-830-2705
Practice Address - Fax:787-830-3059
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR14470208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice