Healthcare Provider Details

I. General information

NPI: 1801820865
Provider Name (Legal Business Name): GLADYS NILDA VISBAL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 12/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 CALLE HARVARD URB. UNIVERSITY GARDENS
SAN JUAN PR
00927-4111
US

IV. Provider business mailing address

270 CALLE HARVARD URB. UNIVERSITY GARDENS
SAN JUAN PR
00927-4111
US

V. Phone/Fax

Practice location:
  • Phone: 787-765-4589
  • Fax: 787-281-6147
Mailing address:
  • Phone: 787-765-4589
  • Fax: 787-281-6147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number003252
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: