Healthcare Provider Details

I. General information

NPI: 1245140698
Provider Name (Legal Business Name): ROBERTO EMMANUEL GANDARA APONTE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO RINCON SECTOR LOMAS CARR14 KM 72.2
CAYEY PR
00736
US

IV. Provider business mailing address

185 CAMINO DEL MONTE
GURABO PR
00778-5230
US

V. Phone/Fax

Practice location:
  • Phone: 787-535-1001
  • Fax:
Mailing address:
  • Phone: 787-914-4088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: