Provider Demographics
NPI:1124080718
Name:GONZALEZ, DENIA E (MD)
Entity type:Individual
Prefix:DR
First Name:DENIA
Middle Name:E
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 1:333 CALLE ISLA VERDE
Mailing Address - Street 2:URB VILLAS DE LA PLAYA
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693-6049
Mailing Address - Country:US
Mailing Address - Phone:787-807-6252
Mailing Address - Fax:787-807-6252
Practice Address - Street 1:2 PATRON STREET
Practice Address - Street 2:
Practice Address - City:MOROVIS
Practice Address - State:PR
Practice Address - Zip Code:00687
Practice Address - Country:US
Practice Address - Phone:787-862-3000
Practice Address - Fax:787-862-2731
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12325207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
8171160OtherTRIPLE SSS
PRI15134Medicare UPIN
0022362Medicare ID - Type Unspecified
I15134Medicare UPIN