Provider Demographics
NPI:1306908215
Name:GONZALEZ, GIOVANNI SR (MD)
Entity type:Individual
Prefix:MR
First Name:GIOVANNI
Middle Name:
Last Name:GONZALEZ
Suffix:SR
Gender:M
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:BOX 9784
Mailing Address - Street 2:COTTO STATION
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-9784
Mailing Address - Country:US
Mailing Address - Phone:787-854-7531
Mailing Address - Fax:787-884-8753
Practice Address - Street 1:CALLE ELLIOT VELEZ B 42
Practice Address - Street 2:URBANIZACION ATENAS
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-854-7531
Practice Address - Fax:787-884-8753
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8124207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
04578OtherAMERICAN HEALTH INC
069557OtherCRUZ AZUL
PR0082933Medicare ID - Type Unspecified
F47615Medicare UPIN