Provider Demographics
NPI:1396873857
Name:GONZALEZ, WILMA
Entity type:Individual
Prefix:
First Name:WILMA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC-03 BOX 11925
Mailing Address - Street 2:
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627-9716
Mailing Address - Country:US
Mailing Address - Phone:787-464-0477
Mailing Address - Fax:
Practice Address - Street 1:CARR. 119 K.M 9.2
Practice Address - Street 2:BO CAMUY ARRIBA
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627
Practice Address - Country:US
Practice Address - Phone:787-820-2148
Practice Address - Fax:787-820-8181
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2819183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician