1912977448 NPI number — DR. GABRIEL J GARCIA-TALAVERA M.D.

Table of content: DR. GABRIEL J GARCIA-TALAVERA M.D. (NPI 1912977448)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912977448 NPI number — DR. GABRIEL J GARCIA-TALAVERA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARCIA-TALAVERA
Provider First Name:
GABRIEL
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912977448
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
COND. PASEOMONTE
Provider Second Line Business Mailing Address:
381 AVE. FELISA RINCON, APT. 902
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00926-6662
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-755-6248
Provider Business Mailing Address Fax Number:
787-977-4813

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1431 AVE PONCE DE LEON
Provider Second Line Business Practice Location Address:
OFIC. 302
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00907-4026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-977-4810
Provider Business Practice Location Address Fax Number:
787-977-4813
Provider Enumeration Date:
01/26/2006

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: 208600000X , with the licence number:  9507 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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