Provider Demographics
NPI:1689865073
Name:GONZALEZ-VIVES, MARIA DEL MAR (MD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:DEL MAR
Last Name:GONZALEZ-VIVES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:232 CALLE ALCANFOR
Mailing Address - Street 2:URB CIUDAD JARDIN
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729
Mailing Address - Country:US
Mailing Address - Phone:787-536-5352
Mailing Address - Fax:
Practice Address - Street 1:26 CALLE FERNANDEZ GARCIA
Practice Address - Street 2:LUQUILLO PLAZA OFIC 14A
Practice Address - City:LUQUILLO
Practice Address - State:PR
Practice Address - Zip Code:00773
Practice Address - Country:US
Practice Address - Phone:787-989-2869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2024-09-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR17074207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRCD948AMedicare PIN