Provider Demographics
NPI:1427500156
Name:GONZALEZ, NILSA IVETTE (RT)
Entity type:Individual
Prefix:
First Name:NILSA
Middle Name:IVETTE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 CALLE HIEDRAS
Mailing Address - Street 2:URB PRADERA REAL
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-7058
Mailing Address - Country:US
Mailing Address - Phone:787-629-1679
Mailing Address - Fax:
Practice Address - Street 1:1240 CALLE HIEDRAS
Practice Address - Street 2:URB PRADERA REAL
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-7058
Practice Address - Country:US
Practice Address - Phone:787-629-1679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16842279G1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredGeneral Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1684OtherJUNTA EXAMINADORA DE TECNICOS DE CUIDADOS RESPIRATORIOS DE PUERTO RICO