Provider Demographics
NPI:1326099243
Name:GOMEZ ALBA, JOSE RAFAEL (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:RAFAEL
Last Name:GOMEZ ALBA
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 1:30 - 12 CALLE PRAVIA
Mailing Address - Street 2:VILLA ASTURIAS
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00983
Mailing Address - Country:US
Mailing Address - Phone:787-769-2867
Mailing Address - Fax:
Practice Address - Street 1:236 AVE SAN MARCOS
Practice Address - Street 2:EXT EL COMANDANTE
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00982
Practice Address - Country:US
Practice Address - Phone:787-768-8544
Practice Address - Fax:787-200-6100
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR64312084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
E36113Medicare UPIN
81801Medicare ID - Type Unspecified