Individual
DEREK GONSALVES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2250 HICKORY RD, SUITE 240, PLYMOUTH MEETING, PA 19462-1047
(610) 834-1122
(610) 825-1604
Mailing address
2220 N 2ND ST, PHILADELPHIA, PA 19133-3301
(267) 258-5649
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN273838
PA
Other
Enumeration date
11/21/2007
Last updated
11/21/2007
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