Provider Demographics
NPI:1992982334
Name:GONZALEZ MARIN, LUDGARDO FERMIN SR (MD)
Entity type:Individual
Prefix:MR
First Name:LUDGARDO
Middle Name:FERMIN
Last Name:GONZALEZ MARIN
Suffix:SR
Gender:M
Credentials:MD
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Mailing Address - Street 1:290 SANTA ANA AVENUE
Mailing Address - Street 2:BUZON 39 TORRIMAR TOWN PARK APTO B-203
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-3361
Mailing Address - Country:US
Mailing Address - Phone:787-585-5518
Mailing Address - Fax:787-790-1304
Practice Address - Street 1:51-46 MAIN AVENUE
Practice Address - Street 2:URBANIZACION SANTA ROSA 2DO PISO
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-585-5518
Practice Address - Fax:787-798-5275
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
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Provider Licenses
StateLicense IDTaxonomies
PR5062PUERTORICO261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)