MEDICARE: DR. GLADYBEL MARIE GORBEA PH.D

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	102L00000X	Psychoanalyst	4126	PR

General Provider Information

NPI Number	:	1861761371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLADYBEL MARIE GORBEA PH.D

Provider Business Mailing Address
First Line	:	3006 AVENIDA SAN CRISTOBAL
Second Line	:	COTO LAUREL,PR 00780-2896
City	:	COTO LAUREL
State	:	PR
Zip	:	00780
Country	:	UM
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3006 AVE SAN CRISTOBAL
Second Line	:	COTO LAUREL,PR 00780-2896
City	:	COTO LAUREL
State	:	PR
Zip	:	00780-2896
Country	:	US
Telephone Number	:	787-949-1572
Fax Number	:	787-843-9642

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

Provider Enumeration Date	:	12/29/2011
Last Update Date	:	12/29/2011

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