Individual
MABEL GONZALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
LODI ST, 571 VILLA CAPRI, RIO PIEDRAS, PR 00924
(787) 758-7790
(787) 758-7790
Mailing address
VISA ARCOIRIS ST, PG 92 PACIFICA, TRUJILLO ALTO, PR 00976
(787) 758-7790
(787) 758-7790
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1292
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041613
CRUZ AZUL
PR
01
—
206238
PREFERRED HEALTH PLAN
PR
01
—
41308GO
TRIPLE S
PR
01
—
4342
FIRST MEDICAL
PR
01
—
70589
PREFERRED MEDICARE CHOICE
PR
01
—
9690043
HUMANA
PR
Enumeration date
11/20/2006
Last updated
07/08/2007
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