Provider Demographics
NPI:1528238268
Name:GONZALEZ, IRIS (MT)
Entity type:Individual
Prefix:MRS
First Name:IRIS
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 CALLE ARZUAGA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00925-3424
Mailing Address - Country:US
Mailing Address - Phone:787-751-6373
Mailing Address - Fax:787-751-6375
Practice Address - Street 1:168 CALLE ARZUAGA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925-3424
Practice Address - Country:US
Practice Address - Phone:787-751-6373
Practice Address - Fax:787-751-6375
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR80291U00000X
PR618291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0038376Medicare PIN
PR0038224Medicare PIN