Provider Demographics
NPI:1295088367
Name:GONZALEZ ROMERO, JEREMIE (LT)
Entity type:Individual
Prefix:MR
First Name:JEREMIE
Middle Name:
Last Name:GONZALEZ ROMERO
Suffix:
Gender:M
Credentials:LT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9022
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-9022
Mailing Address - Country:US
Mailing Address - Phone:787-341-8282
Mailing Address - Fax:
Practice Address - Street 1:251 CALLE PRINCIPAL NUEVA VIDA EL TUQUE
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728
Practice Address - Country:US
Practice Address - Phone:787-341-8282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-25
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG004108225700000X
PR00-25225700000X
PR802225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist