Provider Demographics
NPI:1720705080
Name:GONZALEZ, CATHERINE
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
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:RR #1 BOX 44980
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00685
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CALLE JOSE MENDEZ CARDONA #3
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00685
Practice Address - Country:UM
Practice Address - Phone:787-896-1850
Practice Address - Fax:787-896-1850
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14483183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician