Provider Demographics
NPI:1588961569
Name:GONZALEZ, REBECCA I
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:I
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:JULIO VIZCARRONDO 329
Mailing Address - Street 2:VILLA PALMERAS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00915
Mailing Address - Country:US
Mailing Address - Phone:787-473-1133
Mailing Address - Fax:
Practice Address - Street 1:329 JULIO VIZCARRONDO
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:787-473-1133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5822183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician