Provider Demographics
NPI:1811482029
Name:GONZALEZ, ENID M (RD)
Entity type:Individual
Prefix:
First Name:ENID
Middle Name:M
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 PLAZA SANTA CRUZ
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-6123
Mailing Address - Country:US
Mailing Address - Phone:787-760-6000
Mailing Address - Fax:787-282-3080
Practice Address - Street 1:CALLE DE DIEGO 369 TORRE SAN FRANCISCO
Practice Address - Street 2:SUITE 507
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923
Practice Address - Country:US
Practice Address - Phone:787-282-3000
Practice Address - Fax:787-282-3080
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR832272133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty