Provider Demographics
NPI:1265305957
Name:GONZALEZ, ALBERTO (PA)
Entity type:Individual
Prefix:
First Name:ALBERTO
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 80TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-4158
Mailing Address - Country:US
Mailing Address - Phone:787-763-6432
Mailing Address - Fax:787-777-1366
Practice Address - Street 1:361 CALLE SGTO LUIS MEDINA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3817
Practice Address - Country:US
Practice Address - Phone:787-763-6432
Practice Address - Fax:787-777-1366
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-29
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR002658-P.A.363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty