Provider Demographics
NPI:1386686921
Name:GONASA CORP
Entity type:Organization
Organization Name:GONASA CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PIC/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAMARIS
Authorized Official - Middle Name:MARILIA
Authorized Official - Last Name:RUIZ RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:787-883-2913
Mailing Address - Street 1:HC 83 BOX 6204
Mailing Address - Street 2:SECTOR MONTE REY
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-9706
Mailing Address - Country:US
Mailing Address - Phone:787-883-2913
Mailing Address - Fax:787-270-2593
Practice Address - Street 1:CARR 694 KM 1.2
Practice Address - Street 2:SECTOR MONTE REY BO ESPINOSA
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692
Practice Address - Country:US
Practice Address - Phone:787-270-1816
Practice Address - Fax:787-270-2593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
PR17F22333336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR039850000Medicaid