Carlos Jacobo Gonzalez Sr., M.D.

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

License

19154 Issued in PR

Practice address

2367 Calle Loma
Urb. Valle Alto
Ponce, PR 00730-4146

Phone

(787) 595-0612

NPI assigned

Dec 6, 2014

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in PR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1417824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1443571200000",
    "number": "1124426242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2367 CALLE LOMA",
            "address_2": "URB. VALLE ALTO",
            "city": "PONCE",
            "state": "PR",
            "postal_code": "007304146",
            "telephone_number": "787-595-0612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2367 CALLE LOMA",
            "address_2": "URB. VALLE ALTO",
            "city": "PONCE",
            "state": "PR",
            "postal_code": "007304146",
            "telephone_number": "787-595-0612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALEZ",
        "first_name": "CARLOS",
        "middle_name": "JACOBO",
        "name_prefix": "Dr.",
        "name_suffix": "Sr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-12-06",
        "last_updated": "2015-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "PR",
            "license": "13614",
            "primary": false
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "PR",
            "license": "19154",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anacelys Gonzalez-Viera, PHARM.D.,BCPS
• Ana M Gonzalez, PSY.D
• Anndra Aimee Gonzalez
• Brianna Marlo Gonzalez
• Carlos Alejandro Francisco Gonzalez, MD
• Fabiola Marie Gonzalez, OTR/L
• Frances Ailis Gonzalez
• Gerardo Gonzalez, M.D.
• Javier Gonzalez, MD
• Josue Gonzalez

• Community Health Worker in Ponce, PR
• Providers in Ponce, PR by specialty
• Community Health Worker in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.