Provider Demographics
NPI:1730336108
Name:GONZALEZ PEREZ, ANGEL L
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:L
Last Name:GONZALEZ PEREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:ANGEL
Other - Middle Name:L
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EMS
Mailing Address - Street 1:PO BOX 1438
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-1438
Mailing Address - Country:US
Mailing Address - Phone:787-530-8953
Mailing Address - Fax:787-818-1122
Practice Address - Street 1:CARR 110 KM. 12.8
Practice Address - Street 2:BO PUEBLO
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676
Practice Address - Country:US
Practice Address - Phone:787-530-8953
Practice Address - Fax:787-818-1122
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTC-AMB-1013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0059829Medicare UPIN