Provider Demographics
NPI:1861519167
Name:GONZALEZ-BADILLO, MARYBEL (MD)
Entity type:Individual
Prefix:MRS
First Name:MARYBEL
Middle Name:
Last Name:GONZALEZ-BADILLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PMB 105 HC-01 BOX 29030
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-453-3968
Mailing Address - Fax:
Practice Address - Street 1:DOMENECH AVE #281
Practice Address - Street 2:HATO REY
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-751-2015
Practice Address - Fax:787-751-2015
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13610207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR13610OtherMEDICAL LICENSE