Individual
MRS. IVELISSE GONZALEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
SUITE 603#68 ST. CRUZ ST, TORRE SAN PABLO SUITE #603, BAYAMON, PR 00961-7035
(787) 786-2469
Mailing address
#J10 6TH SREET, EL MIRADOR DE CUPEY, SAN JUAN, PR 00926-7571
(787) 748-6277
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
10207
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
82563GO
SSS
PR
Enumeration date
03/30/2006
Last updated
09/30/2013
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