Provider Demographics
NPI:1255971529
Name:PEREZ-GONZALEZ, JOSE DANIEL
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:DANIEL
Last Name:PEREZ-GONZALEZ
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 1:95 AVE MATIAS BRUGMAN
Mailing Address - Street 2:
Mailing Address - City:LAS MARIAS
Mailing Address - State:PR
Mailing Address - Zip Code:00670-2009
Mailing Address - Country:US
Mailing Address - Phone:787-827-3165
Mailing Address - Fax:
Practice Address - Street 1:95 AVE MATIAS BRUGMAN
Practice Address - Street 2:
Practice Address - City:LAS MARIAS
Practice Address - State:PR
Practice Address - Zip Code:00670-2009
Practice Address - Country:US
Practice Address - Phone:787-827-3165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR003179183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist