Provider Demographics
NPI:1952468076
Name:GONZALEZ, EDNA I (MS)
Entity Type:Individual
Prefix:
First Name:EDNA
Middle Name:I
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MS
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 270265
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00928-3065
Mailing Address - Country:US
Mailing Address - Phone:787-914-8800
Mailing Address - Fax:787-748-0778
Practice Address - Street 1:COOP CIUDAD UNIVERSITARIA
Practice Address - Street 2:1 PERIFERAL AVE. G002 A
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976-2125
Practice Address - Country:US
Practice Address - Phone:787-914-8800
Practice Address - Fax:787-748-0778
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR634235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist