Healthcare Provider Details

I. General information

NPI: 1740474865
Provider Name (Legal Business Name): GABRIEL DE LA TORRE BISOT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2007
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 AVE TITO CASTRO STE 813 TORRE MEDICA SAN LUCAS
PONCE PR
00716-4725
US

IV. Provider business mailing address

909 AVE TITO CASTRO STE 813 TORRE MEDICA SAN LUCAS
PONCE PR
00716-4725
US

V. Phone/Fax

Practice location:
  • Phone: 787-601-4343
  • Fax: 787-418-3462
Mailing address:
  • Phone: 787-601-4343
  • Fax: 787-418-3462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number17371
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number17371
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: