Provider Demographics
NPI:1386050300
Name:GONZALEZ-GOMEZ, ANA EVELYN
Entity type:Individual
Prefix:MRS
First Name:ANA
Middle Name:EVELYN
Last Name:GONZALEZ-GOMEZ
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:#78 CALLE CEDRO
Mailing Address - Street 2:URB. PRADERAS DEL SUR
Mailing Address - City:SANTA ISABEL
Mailing Address - State:PR
Mailing Address - Zip Code:00757
Mailing Address - Country:US
Mailing Address - Phone:787-478-8010
Mailing Address - Fax:
Practice Address - Street 1:8169 CALLE CONCORDIA
Practice Address - Street 2:SUITE 412 COND. SAN VICENTE
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-1567
Practice Address - Country:US
Practice Address - Phone:787-284-5884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR008562163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse