Provider Demographics
NPI:1881896744
Name:GONZALEZ, SHIRLEY MARIE
Entity type:Individual
Prefix:MISS
First Name:SHIRLEY
Middle Name:MARIE
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:URB VILLA FONTANA VIA 8 2NL 254
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00983-3845
Mailing Address - Country:US
Mailing Address - Phone:787-257-4899
Mailing Address - Fax:787-253-3892
Practice Address - Street 1:URB VILLA FONTANA
Practice Address - Street 2:VIA 8 2NL 254
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983-3845
Practice Address - Country:US
Practice Address - Phone:787-257-4899
Practice Address - Fax:787-253-3892
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0273183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician