| Organization Name: | LUIS C GONZALEZ MD |
| NPI Number: | 1154636686 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LUIS CARLOS GONZALEZ (OWNER) |
| Mailing Address: | 181 Interstate Pkwy Bradford |
| State: | PA US |
| Postal Code: | 167011041 |
| Phone Number: | 8143624345 |
| Fax Number: | 8143621178 |
| NPI Enumeration Date: | 08/09/2010 |
| NPI Last Update Date: | 08/09/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AS0400X |
| License Number: | 363AS0400X |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | PA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Surgical |
| Taxonomy Definition: | |