Active NPI
Maribel Gonzalez, DIETICIAN
- Nutritionist
- San Juan, PR
National Provider Identifier
1154523017
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nutritionist
- License
- 969
- Practice address
- 1715 Ave Ponce de Leon
Hospital Auxilio Mutuo, Nutrition Department
San Juan, PR 00909-1958 - Phone
- (787) 758-2000
- NPI assigned
- Jun 4, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nutritionist | 133N00000X | 969 | PR | Primary |
Addresses
Primary practice location
1715 Ave Ponce de Leon
Hospital Auxilio Mutuo, Nutrition Department
San Juan, PR 00909-1958
Mailing address
506 Vereda del Lago
Los Arboles
Carolina, PR 00987-7132
Phone (787) 752-2634
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 969 | Other | PR | DIETITIAN'S LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 969 | PR | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1180915200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1154523017",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "506 VEREDA DEL LAGO",
"address_2": "LOS ARBOLES",
"city": "CAROLINA",
"state": "PR",
"postal_code": "009877132",
"telephone_number": "787-752-2634"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1715 AVE PONCE DE LEON",
"address_2": "HOSPITAL AUXILIO MUTUO, NUTRITION DEPARTMENT",
"city": "SAN JUAN",
"state": "PR",
"postal_code": "009091958",
"telephone_number": "787-758-2000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GONZALEZ",
"first_name": "MARIBEL",
"credential": "DIETICIAN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-06-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "133N00000X",
"taxonomy_group": "",
"desc": "Nutritionist",
"state": "PR",
"license": "969",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DIETITIAN'S LICENSE",
"identifier": "969",
"state": "PR"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Juan, PR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.