1033471768 NPI number — DR. GABRIELA R DE BOER M.D.

Table of content: DR. GABRIELA R DE BOER M.D. (NPI 1033471768)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033471768 NPI number — DR. GABRIELA R DE BOER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DE BOER
Provider First Name:
GABRIELA
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RODRIGUEZ COLON
Provider Other First Name:
GABRIELA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1033471768
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/31/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3445
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HICKORY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28603-3445
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-322-2050
Provider Business Mailing Address Fax Number:
828-324-4271

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PR 1 AVE SAKURA
Provider Second Line Business Practice Location Address:
PLAZA BAIROA SUITE 245
Provider Business Practice Location Address City Name:
CAGUAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-641-3030
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/08/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  2016-00916 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207W00000X , with the licence number: 23423 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 19LIP . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 4188317 . This is a "ENVOLVE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 4188317 . This is a "AETNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: A28835 . This is a "EYEMED" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1033471768 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 13837568 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1853558 . This is a "WELLCARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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