Provider Demographics
NPI:1558462754
Name:UNDA GOMEZ, ROBERTO F (MD)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:F
Last Name:UNDA GOMEZ
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 1:1357 ASHFORD AVENUE
Mailing Address - Street 2:SUITE #2, PMB 250
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907
Mailing Address - Country:US
Mailing Address - Phone:787-726-0055
Mailing Address - Fax:787-689-5833
Practice Address - Street 1:#29 WASHINGTON ST. SUITE #403
Practice Address - Street 2:ASHFORD MEDICAL CENTER
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907
Practice Address - Country:US
Practice Address - Phone:787-726-0055
Practice Address - Fax:787-689-5833
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14598208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0021558Medicare ID - Type Unspecified