Doctor Name: | MARIO ENRIQUE GONZALEZ BAUZA |
NPI Number: | 1205836301 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 2010 |
Business Practice Address: | 3 Calle Del Carmen Rio Grande, PR - 007453026 |
Business Phone Number: | 7878873259 |
Business Fax Number: | |
Mailing Address: | 3 Calle Del Carmen, Po Box 817 RIO GRANDE |
State: | PR |
Postal Code: | 007453026 |
Phone Number: | 7878873259 |
Fax Number: | |
NPI Enumeration Date: | 07/29/2005 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 2010 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PR |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |