Provider Demographics
NPI:1376370122
Name:PEREZ GONZALEZ, GRETCHEN L (MD)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:L
Last Name:PEREZ GONZALEZ
Suffix:
Gender:F
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:PO BOX 435
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-0435
Mailing Address - Country:US
Mailing Address - Phone:787-566-1411
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 435
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-0435
Practice Address - Country:US
Practice Address - Phone:787-566-1411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15723104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker