Provider Demographics
NPI:1770344137
Name:GONZALEZ, ROSARITO
Entity type:Individual
Prefix:
First Name:ROSARITO
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:PO BOX 505
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-0505
Mailing Address - Country:US
Mailing Address - Phone:787-925-0112
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 308 KM 5.8 INTERIOR
Practice Address - Street 2:BARRIO MIRADERO
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623-0062
Practice Address - Country:US
Practice Address - Phone:787-925-0112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2000363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant