Provider Demographics
NPI:1720084171
Name:GONZALEZ-CANCEL, IVAN F (MD)
Entity Type:Individual
Prefix:DR
First Name:IVAN
Middle Name:F
Last Name:GONZALEZ-CANCEL
Suffix:
Gender:M
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:PMB NUM 476
Mailing Address - Street 2:PO BOX 70344
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-8344
Mailing Address - Country:US
Mailing Address - Phone:787-281-0451
Mailing Address - Fax:787-281-0450
Practice Address - Street 1:AVE AMERICO MIRANDA
Practice Address - Street 2:NUM 401
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927
Practice Address - Country:US
Practice Address - Phone:787-281-0451
Practice Address - Fax:787-281-0450
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9454208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
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