Provider Demographics
NPI:1427897404
Name:GONZALEZ MALDONODO, ISMAEL (MD)
Entity type:Individual
Prefix:
First Name:ISMAEL
Middle Name:
Last Name:GONZALEZ MALDONODO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 3 BOX 13261
Mailing Address - Street 2:
Mailing Address - City:PENUELAS
Mailing Address - State:PR
Mailing Address - Zip Code:00624-9822
Mailing Address - Country:US
Mailing Address - Phone:787-901-6892
Mailing Address - Fax:
Practice Address - Street 1:HC 3 BOX 13261
Practice Address - Street 2:
Practice Address - City:PENUELAS
Practice Address - State:PR
Practice Address - Zip Code:00624-9822
Practice Address - Country:US
Practice Address - Phone:787-901-6892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-21
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR023857208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice