Provider Demographics
NPI:1750512604
Name:GONZALEZ, JAVIER (MD)
Entity type:Individual
Prefix:
First Name:JAVIER
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JAVIER
Other - Middle Name:
Other - Last Name:GONZALEZ-CASTRO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1353 AVE LUIS VIGOREAUX
Mailing Address - Street 2:PMB 841
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966
Mailing Address - Country:US
Mailing Address - Phone:787-717-8911
Mailing Address - Fax:
Practice Address - Street 1:VILLA CAPARRA
Practice Address - Street 2:60 CALLE 8
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966
Practice Address - Country:US
Practice Address - Phone:787-717-8911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-27
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD165384207Y00000X
PR19036207YX0007X, 207YX0905X
PR12380284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
No284300000XHospitalsSpecial Hospital