# SAN LAZARGERD MEDICAL CENTER, CSP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629340138
- **Authorized official:** DR. GERALDO GONZALEZ-GONZALEZ M.D. (PRESIDENT)
- **Authorized official phone:** (787) 897-0353

## Contact information

- **Practice address:** CARR 129 KM 27.3, LARES, PR 00669
- **Practice address phone:** (787) 897-0353
- **Practice address fax:** (787) 897-3979
- **Mailing address:** PO BOX 428, LARES, PR 00669-0428

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RC0000X | Cardiovascular Disease Physician | — | NULL | — |
| 207RC0000X | Cardiovascular Disease Physician | — | — | — |
| 2085B0100X | Body Imaging Physician | — | NULL | — |
| 2085B0100X | Body Imaging Physician | — | — | — |
| 208D00000X | General Practice Physician | — | NULL | — |
| 208D00000X | General Practice Physician | — | — | — |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 01/30/2012
- **Last updated:** 04/18/2012