Provider Demographics
NPI:1942858493
Name:CENTRO DE ENDOCRINOLOGIA ALCANTARA GONZALEZ, LLC
Entity type:Organization
Organization Name:CENTRO DE ENDOCRINOLOGIA ALCANTARA GONZALEZ, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALTAGRACIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALCANTARA GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-787-0933
Mailing Address - Street 1:UU-1 CALLE 39 PMB 302
Mailing Address - Street 2:URB. SANTA JUANITA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-4792
Mailing Address - Country:US
Mailing Address - Phone:787-787-0933
Mailing Address - Fax:787-778-0230
Practice Address - Street 1:SANTA JUANITA
Practice Address - Street 2:CALLE 37 TT-14
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-787-0933
Practice Address - Fax:787-778-0230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR11898OtherLICENCE NUMBER