Healthcare Provider Details

I. General information

NPI: 1699845602
Provider Name (Legal Business Name): GLADYS E NEGRON M.D. PSC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 10/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARIBBEAN CINEMA SECOND FLOOR #1 OFIC
BARCELONETA PR
00617
US

IV. Provider business mailing address

50 CALLE MARLIN AZUL
VEGA BAJA PR
00693-3559
US

V. Phone/Fax

Practice location:
  • Phone: 940-382-5230
  • Fax:
Mailing address:
  • Phone: 939-202-1848
  • Fax: 888-859-5656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberA065789
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number18436
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier18436
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerPUERTO RICO STAT MEDICAL LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: