Provider Demographics
NPI:1679554455
Name:GONZALEZ, MARIBEL (MT)
Entity type:Individual
Prefix:MRS
First Name:MARIBEL
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MT
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 2003
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-8003
Mailing Address - Country:US
Mailing Address - Phone:787-896-1076
Mailing Address - Fax:787-896-1076
Practice Address - Street 1:1488 AVE EMERITO ESTRADA RIVERA
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-3023
Practice Address - Country:US
Practice Address - Phone:787-896-1076
Practice Address - Fax:787-896-1076
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3565246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0031439Medicare PIN