Healthcare Provider Details

I. General information

NPI: 1104010651
Provider Name (Legal Business Name): PEDRO GIL SOLIVAN ORTIZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 01/28/2020
Certification Date: 01/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

369 AVE JOSE DE DIEGO TORRE SAN FRANCISCO OFICINA 603
RIO PIEDRAS PR
00923
US

IV. Provider business mailing address

TORRE SAN FRANCISCO #369 AVE. DE DIEGO OFIC 603
SAN JUAN PR
00923
US

V. Phone/Fax

Practice location:
  • Phone: 787-753-6022
  • Fax: 787-753-6066
Mailing address:
  • Phone: 787-753-6022
  • Fax: 787-753-6066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number17625
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number17625
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number17625
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: