Provider Demographics
NPI:1699878017
Name:GONZALEZ-BERDECIA, CARLOS ALBERTO
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:ALBERTO
Last Name:GONZALEZ-BERDECIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7503
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-7503
Mailing Address - Country:US
Mailing Address - Phone:787-840-3510
Mailing Address - Fax:787-840-3510
Practice Address - Street 1:URB. LAS DELICIAS
Practice Address - Street 2:1204 CALLE FCO. VASALLO
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728-3838
Practice Address - Country:US
Practice Address - Phone:787-840-3510
Practice Address - Fax:787-840-3510
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6748208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR27891GOOtherTRIPLE S
PR061882OtherCRUZ AZUL
PR200049OtherMEDICARE Y MUCHO MAS
PR7320071OtherHUMANA
PR2881OtherINTERNATIONAL MEDICAL CAR
PR3606748OtherUIA
PR2881OtherINTERNATIONAL MEDICAL CAR
PR3606748OtherUIA