Healthcare Provider Details

I. General information

NPI: 1942832233
Provider Name (Legal Business Name): GABRIEL NUNZIO FRATTALLONE LLADO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2020
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CENTRO MEDICO DE PUERTO RICO
SAN JUAN PR
00935-0001
US

IV. Provider business mailing address

CENTRO MEDICO PUERTO RICO
SAN JUAN PR
00935-0001
US

V. Phone/Fax

Practice location:
  • Phone: 787-777-3535
  • Fax:
Mailing address:
  • Phone: 787-777-3535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number24352
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: