Provider Demographics
NPI:1679781595
Name:GONZALEZ LIBOY, GONZALO V (MD FACP)
Entity type:Individual
Prefix:MR
First Name:GONZALO
Middle Name:V
Last Name:GONZALEZ LIBOY
Suffix:
Gender:M
Credentials:MD FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 ISTA VERDE AVE
Mailing Address - Street 2:APT 11-6-W LOS PINOS
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979
Mailing Address - Country:US
Mailing Address - Phone:787-253-0962
Mailing Address - Fax:787-773-8303
Practice Address - Street 1:10 PISO EDIF
Practice Address - Street 2:FARMACIA CENTUO MEDICO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00936-8344
Practice Address - Country:US
Practice Address - Phone:787-773-8283
Practice Address - Fax:787-773-8303
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2606207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E35541Medicare UPIN
22291Medicare ID - Type Unspecified