Provider Demographics
NPI:1811964869
Name:GONZALEZ SOTOMAYOR, ANTONIO (MD)
Entity type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:
Last Name:GONZALEZ SOTOMAYOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:GALERIAS PONCENAS UNION ST # 83
Mailing Address - Street 2:SUIT 14
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-1632
Mailing Address - Country:US
Mailing Address - Phone:787-284-6261
Mailing Address - Fax:
Practice Address - Street 1:1563 CALLE DAMASCO
Practice Address - Street 2:SAN ANTONIO
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728-1632
Practice Address - Country:US
Practice Address - Phone:787-202-6822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15531208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0023049Medicare UPIN