Provider Demographics
NPI:1316339302
Name:GONZALEZ, RICARDO (DC)
Entity type:Individual
Prefix:
First Name:RICARDO
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:692 CALLE MEDITERRANEO
Mailing Address - Street 2:EXT EL COMANDANTE
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00982-3632
Mailing Address - Country:US
Mailing Address - Phone:787-392-5200
Mailing Address - Fax:
Practice Address - Street 1:AVE EL COMANDANTE CALLE 266,
Practice Address - Street 2:PB 30 COUNTRY CLUB
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00982
Practice Address - Country:US
Practice Address - Phone:787-392-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-27
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR540111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor