Provider Demographics
NPI:1932199783
Name:GONZALEZ, MARIA DEL CARMEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:DEL CARMEN
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 CALLE DR BASORA N
Mailing Address - Street 2:EDIFICIO MEDICO IV STE 102
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-4810
Mailing Address - Country:US
Mailing Address - Phone:787-833-0420
Mailing Address - Fax:787-833-0420
Practice Address - Street 1:55 CALLE DR BASORA N
Practice Address - Street 2:EDIFICIO MEDICO IV STE 102
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4810
Practice Address - Country:US
Practice Address - Phone:787-833-0420
Practice Address - Fax:787-833-0420
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6951174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0098502OtherSSS PROVIDER NUMBER
PRE19228Medicare UPIN
PR0082010EMedicare ID - Type Unspecified