Provider Demographics
NPI:1922849991
Name:GONZALEZ MARTINEZ, CARLOS ENRIQUE (MD)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:ENRIQUE
Last Name:GONZALEZ MARTINEZ
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 1:8251 SW 157TH AVE APT 104
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-1282
Mailing Address - Country:US
Mailing Address - Phone:786-440-3781
Mailing Address - Fax:
Practice Address - Street 1:100 AVE LUIS MUNOZ MARIN
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-6184
Practice Address - Country:US
Practice Address - Phone:787-653-3434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16823-I390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program