Provider Demographics
NPI:1861256927
Name:GONZALEZ-GARCIA, EDGARDO RUBEN
Entity type:Individual
Prefix:
First Name:EDGARDO
Middle Name:RUBEN
Last Name:GONZALEZ-GARCIA
Suffix:
Gender:M
Credentials:
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 565
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00792-0565
Mailing Address - Country:US
Mailing Address - Phone:787-328-2127
Mailing Address - Fax:
Practice Address - Street 1:CARR. 917 KM. 0.1 SEC. EULOGIO REYES BO. TEJAS
Practice Address - Street 2:
Practice Address - City:LAS PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00771
Practice Address - Country:US
Practice Address - Phone:787-328-2127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-09
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program