Provider Demographics
NPI:1487763199
Name:FALCON, GONZALO (MD)
Entity type:Individual
Prefix:
First Name:GONZALO
Middle Name:
Last Name:FALCON
Suffix:
Gender:M
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:PO BOX 4956
Mailing Address - Street 2:PMB 1133
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-4956
Mailing Address - Country:US
Mailing Address - Phone:787-745-2888
Mailing Address - Fax:787-745-2888
Practice Address - Street 1:AVE. JOSE VILLARES
Practice Address - Street 2:DELGADO O-13
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-961-0199
Practice Address - Fax:787-626-5219
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9691207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F08082Medicare UPIN
PR82272Medicare ID - Type Unspecified