Provider Demographics
NPI:1205812278
Name:GONZALEZ, JESUS (MD)
Entity type:Individual
Prefix:MR
First Name:JESUS
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:D8 CALLE VAN GOGH
Mailing Address - Street 2:5TAS DE SAN LUIS
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-7622
Mailing Address - Country:US
Mailing Address - Phone:787-258-4936
Mailing Address - Fax:787-258-4936
Practice Address - Street 1:HIMA AVE LUIS MUNOZ MARIN
Practice Address - Street 2:STE 114
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-258-4936
Practice Address - Fax:787-258-4936
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8576207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR80048GOOtherTRIPLE S
PR28576OtherMEDICAL CARD SYSTEM
PRM6783OtherCRUZ AZUL
PR28576OtherMEDICAL CARD SYSTEM