Provider Demographics
NPI:1750394078
Name:GONZALEZ, SASHA MARA (MD)
Entity type:Individual
Prefix:DR
First Name:SASHA
Middle Name:MARA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:425 CARR 693
Mailing Address - Street 2:PMB #194
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-4802
Mailing Address - Country:US
Mailing Address - Phone:787-549-1818
Mailing Address - Fax:787-626-4708
Practice Address - Street 1:BARCELONETA PRIME OUTLETS CARR.#2 KM. 54.6
Practice Address - Street 2:INTERSECCION CARR. 140 , BO. MANATI ABAJO
Practice Address - City:BARCELONETA
Practice Address - State:PR
Practice Address - Zip Code:00617
Practice Address - Country:US
Practice Address - Phone:787-607-1223
Practice Address - Fax:787-626-4708
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR15605208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR128944Medicare UPIN
PR0023017Medicare ID - Type Unspecified