Provider Demographics
NPI:1396913125
Name:GONZALEZ, MARIA L (OD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:L
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10TH.ST.#5-39
Mailing Address - Street 2:ALTURAS DE TORRIMAR
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-579-7726
Mailing Address - Fax:
Practice Address - Street 1:10TH.ST. #5-39
Practice Address - Street 2:ALTURAS DE TORRIMAR
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-3211
Practice Address - Country:US
Practice Address - Phone:787-579-7726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-14
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR178152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist