Provider Demographics
NPI:1184692840
Name:GONZALEZ, CARLOS A (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:A
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 13028
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00908-3028
Mailing Address - Country:US
Mailing Address - Phone:787-757-6900
Mailing Address - Fax:787-768-4800
Practice Address - Street 1:ROBERTO CLEMENTE HSING
Practice Address - Street 2:SUITE #11
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987-7329
Practice Address - Country:US
Practice Address - Phone:787-757-6900
Practice Address - Fax:787-768-4800
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6499207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE31500Medicare UPIN