Healthcare Provider Details

I. General information

NPI: 1164567954
Provider Name (Legal Business Name): ALCIDES GIL ESCUDERO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 02/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 SANTA CRUZ AVENUE TORRE SAN PABLO SUITE 701
BAYAMON PR
00959
US

IV. Provider business mailing address

28 ACEROLA ST MILAVILLE
SAN JUAN PR
00926-5105
US

V. Phone/Fax

Practice location:
  • Phone: 787-798-4527
  • Fax: 787-790-4580
Mailing address:
  • Phone: 787-789-7823
  • Fax: 787-708-9026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number3889
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: