Provider Demographics
NPI:1053031567
Name:GONZALEZ, CHRISTIAN D (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:D
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
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 3446
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-3446
Mailing Address - Country:US
Mailing Address - Phone:787-519-2859
Mailing Address - Fax:
Practice Address - Street 1:URB. VILLALINDA #237
Practice Address - Street 2:AVE. INTERAMERICANA
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-519-2859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-02
Last Update Date:2022-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1426-PA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant