Provider Demographics
NPI:1235596347
Name:CABANILLAS CASTILLO, GYSSEL ELIZA (MD)
Entity Type:Individual
Prefix:DR
First Name:GYSSEL
Middle Name:ELIZA
Last Name:CABANILLAS CASTILLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 CALLE ENRIQUE VAZQUEZ BAEZ
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-3645
Mailing Address - Country:US
Mailing Address - Phone:787-447-4240
Mailing Address - Fax:
Practice Address - Street 1:110 CALLE ENRIQUE VAZQUEZ BAEZ
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-3645
Practice Address - Country:US
Practice Address - Phone:787-447-4240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19233208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice