Provider Demographics
NPI:1780956375
Name:GONZALEZ, ANTONIO
Entity type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
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 1218
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-1218
Mailing Address - Country:US
Mailing Address - Phone:787-242-7551
Mailing Address - Fax:
Practice Address - Street 1:BO PLAYITA
Practice Address - Street 2:C 71
Practice Address - City:SALINAS
Practice Address - State:PR
Practice Address - Zip Code:00751
Practice Address - Country:US
Practice Address - Phone:787-242-7551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-30
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2168E163WI0600X, 163WP0808X
PR32920163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WI0600XNursing Service ProvidersRegistered NurseInfection Control
No163W00000XNursing Service ProvidersRegistered Nurse