Provider Demographics
NPI:1588957765
Name:GONZALEZ, ISIDRA
Entity type:Individual
Prefix:MS
First Name:ISIDRA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC01 BOX 2253 BO. LA PRIETA
Mailing Address - Street 2:
Mailing Address - City:COMERIO
Mailing Address - State:PR
Mailing Address - Zip Code:00782
Mailing Address - Country:US
Mailing Address - Phone:787-423-1350
Mailing Address - Fax:
Practice Address - Street 1:2039 BORINQUEN AVE.
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00915
Practice Address - Country:US
Practice Address - Phone:787-726-7558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-23
Last Update Date:2025-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR171191041C0700X
PR7808183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No183700000XPharmacy Service ProvidersPharmacy Technician