Provider Demographics
NPI:1932709805
Name:DR IVAN F GONZALEZ-CANCEL, LLC
Entity Type:Organization
Organization Name:DR IVAN F GONZALEZ-CANCEL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:GONZALEZ-CANCEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-281-0451
Mailing Address - Street 1:PO BOX 70344
Mailing Address - Street 2:PMB 476
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-8344
Mailing Address - Country:US
Mailing Address - Phone:787-281-0451
Mailing Address - Fax:787-281-0450
Practice Address - Street 1:PUERTO RICO CARDIOVASCULAR CENTER
Practice Address - Street 2:1ST FLOOR, SUITE #2
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00936
Practice Address - Country:US
Practice Address - Phone:787-281-0451
Practice Address - Fax:787-281-0450
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR IVAN F GONZALEZ-CANCEL, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty