Provider Demographics
NPI:1407903917
Name:SANCHEZ, GUSTAVO R (MD)
Entity Type:Individual
Prefix:DR
First Name:GUSTAVO
Middle Name:R
Last Name:SANCHEZ
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 1:23 CALLE BALDORIOTY W
Mailing Address - Street 2:BOX 2159
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00784-5338
Mailing Address - Country:US
Mailing Address - Phone:787-864-4191
Mailing Address - Fax:787-866-8171
Practice Address - Street 1:23 OESTE CALLE BALDORIOTY
Practice Address - Street 2:
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784
Practice Address - Country:US
Practice Address - Phone:787-864-4191
Practice Address - Fax:787-866-8171
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07210207V00000X, 207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRD99595Medicare ID - Type Unspecified