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General NPI Number Information
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NPI Number | 1477212884
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Entity Type | Individual
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Provider Name | SIBASKY GONZALEZ SANTOS MD
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Gender | Male
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Dates
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Enumeration Date | 12/13/2021
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Last Update Date | 05/09/2023
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Provider Practice Location Address
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Address Line | CARR. EST. PR-460, KM. 0.1, BO. CAIMITAL ALTO
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City | AGUADILLA
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State | PR
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Zip | 00603
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Country | US
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Telephone | 787-659-0000
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Fax |
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Provider Business Mailing Address
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Address Line | LAS CASONAS C19
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City | AGUADA
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State | PR
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Zip | 00602
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Country | US
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Telephone | 787-370-7107
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 001590-PA
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | PR
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 23216
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License Number State | PR
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