Provider Demographics
NPI:1245067750
Name:GONZALEZ, JUAN L (NL)
Entity type:Individual
Prefix:MR
First Name:JUAN
Middle Name:L
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:NL
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 9
Mailing Address - Street 2:
Mailing Address - City:FLORIDA
Mailing Address - State:PR
Mailing Address - Zip Code:00650-0009
Mailing Address - Country:US
Mailing Address - Phone:787-439-8387
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 9
Practice Address - Street 2:
Practice Address - City:FLORIDA
Practice Address - State:PR
Practice Address - Zip Code:00650-0009
Practice Address - Country:US
Practice Address - Phone:787-439-8387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR243175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath