Provider Demographics
NPI:1184449464
Name:GONZALEZ AGUAYO, MARIA M (PA)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:M
Last Name:GONZALEZ AGUAYO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 4 BOX 5401
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00971-9300
Mailing Address - Country:US
Mailing Address - Phone:787-585-6447
Mailing Address - Fax:
Practice Address - Street 1:HC 4 BOX 5401
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00971-9300
Practice Address - Country:US
Practice Address - Phone:787-585-6447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-20
Last Update Date:2024-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2205363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant