Provider Demographics
NPI:1407303282
Name:CASTRO COLON, GABRIEL ROBERTO
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:ROBERTO
Last Name:CASTRO COLON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1379 PASEO DON JUAN APT 6A
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-1461
Mailing Address - Country:US
Mailing Address - Phone:787-918-4356
Mailing Address - Fax:
Practice Address - Street 1:1395 CALLE SAN RAFAEL
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2518
Practice Address - Country:US
Practice Address - Phone:787-999-7620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-08
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR019322207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine