Healthcare Provider Details

I. General information

NPI: 1053427443
Provider Name (Legal Business Name): GILBERTO A SOLIVAN ACOSTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 SAN JULIAN
SAN JUAN PR
00926
US

IV. Provider business mailing address

440 CALLE SAN JULIAN
SAN JUAN PR
00926-4217
US

V. Phone/Fax

Practice location:
  • Phone: 787-764-3024
  • Fax: 787-789-1921
Mailing address:
  • Phone: 787-685-5895
  • Fax: 787-789-1921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number16505
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: