Provider Demographics
NPI:1013064500
Name:GONZALEZ, JOEL
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:
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 366794
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-6794
Mailing Address - Country:US
Mailing Address - Phone:939-640-9559
Mailing Address - Fax:787-761-8187
Practice Address - Street 1:CALLE CERRA FINAL 900
Practice Address - Street 2:CENTRO DR. GUALBERTO RABELL
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00907
Practice Address - Country:US
Practice Address - Phone:787-723-1360
Practice Address - Fax:787-723-6247
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14730208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice