Mairalisa Gomez-Fortuna, M.D.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

9438 Issued in PR

Practice address

Calle Palmer # 8
Esquina Calderon Mujica
Canovanas, PR 00729

Phone

(787) 876-0849

Fax

(787) 876-0849

NPI assigned

Jan 30, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

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": "1170115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1992842090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 1405",
            "city": "CANOVANAS",
            "state": "PR",
            "postal_code": "00729",
            "telephone_number": "787-876-0849",
            "fax_number": "787-876-0849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CALLE PALMER # 8",
            "address_2": "ESQUINA CALDERON MUJICA",
            "city": "CANOVANAS",
            "state": "PR",
            "postal_code": "00729",
            "telephone_number": "787-876-0849",
            "fax_number": "787-876-0849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOMEZ-FORTUNA",
        "first_name": "MAIRALISA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "PR",
            "license": "9438",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jose A. Gaudier Diaz, M.D.
• Gelycan Corp
• Aleisa Gines, OTL
• Glorimar Santos Llanos PSC
• Wilfred Gomez Saldana, MD
• Juan Gonzalez Diaz, MD
• Bethzaida Gonzalez Galarza
• Luz Yiraida Gonzalez Rodriguez, PHD.
• Juan a Gonzalez Skerrett, MD
• Elia M. Gonzalez, RPT

• General Practice Physician in Canovanas, PR
• Providers in Canovanas, PR by specialty
• General Practice Physician in Puerto Rico

• 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.
• 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.