Provider Demographics
NPI:1316977747
Name:GONZALEZ, MARIE D (MD)
Entity type:Individual
Prefix:MISS
First Name:MARIE
Middle Name:D
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 371235
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00737-1235
Mailing Address - Country:US
Mailing Address - Phone:787-738-3283
Mailing Address - Fax:787-263-1865
Practice Address - Street 1:AVE JOSE DE DIEGO 165 OESTE
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00737
Practice Address - Country:US
Practice Address - Phone:787-738-3283
Practice Address - Fax:787-263-1865
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2022-05-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR12854207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0089756OtherTRIPLE-S
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PR200049OtherPREFERRED HEALTH
PRM00379OtherMENONITA
PR89756OtherMEDICARE
PR2038OtherAMERICAN HEALTH
PR400043OtherMEDICARE Y MUCHO MAS