Healthcare Provider Details

I. General information

NPI: 1033574405
Provider Name (Legal Business Name): GUSTAVO R. SANCHEZ MD, FACOG CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2015
Last Update Date: 12/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 CALLE BALDORIOTY W
GUAYAMA PR
00784-5338
US

IV. Provider business mailing address

PO BOX 2159
GUAYAMA PR
00785-2159
US

V. Phone/Fax

Practice location:
  • Phone: 787-864-4191
  • Fax: 787-866-8171
Mailing address:
  • Phone: 787-864-4191
  • Fax: 787-866-8171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number07210
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code2088F0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Urology) Physician
License Number07210
License Number StatePR

VIII. Authorized Official

Name: DR. GUSTAVO R SANCHEZ
Title or Position: PRESIDENT
Credential: MD
Phone: 787-864-4191