Healthcare Provider Details

I. General information

NPI: 1720063332
Provider Name (Legal Business Name): GILBERTO RUIZ DEYA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 AVE TITO CASTRO STE. 102, PMB 363
PONCE PR
00716-0200
US

IV. Provider business mailing address

609 AVE TITO CASTRO STE. 102, PMB 363
PONCE PR
00716-0200
US

V. Phone/Fax

Practice location:
  • Phone: 787-284-3333
  • Fax: 787-284-1722
Mailing address:
  • Phone: 787-284-3333
  • Fax: 787-284-1722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number13510
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: