Provider Demographics
NPI:1205810363
Name:GONZALEZ PANTALEON, PEDRO BALTAZAR
Entity type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:BALTAZAR
Last Name:GONZALEZ PANTALEON
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 1356
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-1356
Mailing Address - Country:US
Mailing Address - Phone:787-879-1701
Mailing Address - Fax:787-879-1701
Practice Address - Street 1:V1 CALLE 16
Practice Address - Street 2:URB. VILLA LOS SANTOS
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-3112
Practice Address - Country:US
Practice Address - Phone:787-879-1701
Practice Address - Fax:787-879-1701
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-02
Last Update Date:2025-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4362207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4362OtherMEDICAL LICENSE # IN PR
PRE43171Medicare UPIN