MEDICARE: GABRIEL ANTONIO SANTIAGO COLBERG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	24666	PR

General Provider Information

NPI Number	:	1316726011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIEL ANTONIO SANTIAGO COLBERG MD

Provider Business Mailing Address
First Line	:	PO BOX 1743
Second Line	:
City	:	CABO ROJO
State	:	PR
Zip	:	00623-1743
Country	:	US
Telephone Number	:	787-366-0285
Fax Number	:

Provider Business Practice Location Address
First Line	:	AVE. HOSTOS 410 CARRETERA 2
Second Line	:
City	:	MAYAGUEZ
State	:	PR
Zip	:	00680
Country	:	US
Telephone Number	:	787-652-9200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2023
Last Update Date	:	06/04/2026

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