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General NPI Number Information
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NPI Number | 1669489183
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Entity Type | Individual
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Provider Name | ROBERTO JUAN GANDARA M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 2 CALLE MUNOZ RIVERA ESQUINA GOYCO
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City | CAGUAS
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State | PR
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Zip | 00725-2603
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Country | US
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Telephone | 787-286-2800
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Fax | 787-745-2425
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Provider Business Mailing Address
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Address Line | PO BOX 1357
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City | CAGUAS
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State | PR
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Zip | 00726-1357
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Country | US
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Telephone | 787-745-3508
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 329
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 11223
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License Number State | PR
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