Provider Demographics
NPI:1588469571
Name:GONZALEZ, WALESKA (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:WALESKA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 2 BOX 13767
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-9750
Mailing Address - Country:US
Mailing Address - Phone:787-627-1612
Mailing Address - Fax:
Practice Address - Street 1:500 AVENIDA DEGETAU, HIMA PLAZA 1, SUITE 308 CAGUAS, PR
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00778
Practice Address - Country:US
Practice Address - Phone:787-474-7678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR367-P.A363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical