Basic Information
| Provider Information | |||||||||
| NPI: | 1346286408 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GONZALEZ | ||||||||
| FirstName: | NANETTE | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | URB LAS VEREDAS 169 | ||||||||
| Address2: | LAS VEREDAS DE LAS PALMAS | ||||||||
| City: | GURABO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007789680 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876167287 | ||||||||
| FaxNumber: | 7877285136 | ||||||||
| Practice Location | |||||||||
| Address1: | 252 CALLE SAN JORGE | ||||||||
| Address2: | SUITE 406 SAN JORGE MEDICAL OFFICE | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009123310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877260210 | ||||||||
| FaxNumber: | 7877285136 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 13443 | PR | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 20430 | 01 | PR | SSS | OTHER |