Provider Demographics
NPI:1215911771
Name:GONZALEZ SEGUI, YVELISSE
Entity type:Individual
Prefix:DR
First Name:YVELISSE
Middle Name:
Last Name:GONZALEZ SEGUI
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 BALDRICH
Mailing Address - Street 2:AVE HOSTOS 514 B
Mailing Address - City:HATO REY
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:787-766-1575
Mailing Address - Fax:787-766-1574
Practice Address - Street 1:URB BALDRICH
Practice Address - Street 2:AVE HOSTOS 514 B
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-766-1575
Practice Address - Fax:787-766-1574
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR71072085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR98703GOOtherTRIPLE S
PR98703GOOtherTRIPLE S
PRE14604Medicare UPIN