Provider Demographics
NPI:1790501088
Name:HAGERMAN, GONZALO
Entity type:Individual
Prefix:MR
First Name:GONZALO
Middle Name:
Last Name:HAGERMAN
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:DONATELLO #59
Mailing Address - Street 2:
Mailing Address - City:INSURGENTES
Mailing Address - State:MEXICO CITY
Mailing Address - Zip Code:03920
Mailing Address - Country:MX
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:DONATELLO #59
Practice Address - Street 2:
Practice Address - City:INSURGENTES
Practice Address - State:MEXICO CITY
Practice Address - Zip Code:03920
Practice Address - Country:MX
Practice Address - Phone:525-527-5157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program