=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558178533
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | G & Z WELLNESS AND HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2024
-----------------------------------------------------
Last Update Date | 12/19/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 126 CALLE CARMELO MARTINEZ STE 2 LOCAL D
-----------------------------------------------------
City | MAYAGUEZ
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00682-3041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-505-5052
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 126 CARMELO MARTINEZ STE 2 LOCAL D
-----------------------------------------------------
City | MAYAGUEZ
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00680
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. GYSSEL CABANILLAS CASTILLO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 787-447-4240
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------