Provider Demographics
NPI:1316528425
Name:GONZALEZ, ELISA MARGARITA
Entity type:Individual
Prefix:
First Name:ELISA
Middle Name:MARGARITA
Last Name:GONZALEZ
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:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-0097
Mailing Address - Country:US
Mailing Address - Phone:787-312-1428
Mailing Address - Fax:
Practice Address - Street 1:60 AVE LOS DOMINICOS
Practice Address - Street 2:
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-4724
Practice Address - Country:US
Practice Address - Phone:787-795-8630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3076183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician