Healthcare Provider Details

I. General information

NPI: 1144137985
Provider Name (Legal Business Name): GBR MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 CALLE FARAYON ALTURAS DE MAYAGUEZ
MAYAGUEZ PR
00682
US

IV. Provider business mailing address

3333 CALLE FARAYON ALTURAS DE MAYAGUEZ
MAYAGUEZ PR
00682
US

V. Phone/Fax

Practice location:
  • Phone: 787-428-5199
  • Fax:
Mailing address:
  • Phone: 787-428-5199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: GISEL M BONILLA REYES
Title or Position: DIRECTORA
Credential: MD
Phone: 787-428-5199