Provider Demographics
NPI:1124025358
Name:GOMEZ ADROVER, REYNALDO (MD)
Entity Type:Individual
Prefix:
First Name:REYNALDO
Middle Name:
Last Name:GOMEZ ADROVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 414
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-0414
Mailing Address - Country:US
Mailing Address - Phone:787-854-6562
Mailing Address - Fax:787-884-0253
Practice Address - Street 1:CARR 149 # KM1H3
Practice Address - Street 2:RPTO VILLA ALBERTA # 2
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-9670
Practice Address - Country:US
Practice Address - Phone:787-854-6562
Practice Address - Fax:787-884-0253
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10351208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR83156GOMedicaid
PR83156GOMedicaid
PRBG2864874OtherDEA
PR0083156Medicare ID - Type UnspecifiedPROVIDER NUM