Provider Demographics
NPI:1578557435
Name:DELIZ-FIGUEROA, GLADYS SANDRA (MD)
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:SANDRA
Last Name:DELIZ-FIGUEROA
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 1:73 CALLE SANTA CRUZ
Mailing Address - Street 2:EDIFICIO MEDICO SANTA CRUZ, SUITE 304
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-6910
Mailing Address - Country:US
Mailing Address - Phone:787-269-3986
Mailing Address - Fax:787-995-3775
Practice Address - Street 1:73 CALLE SANTA CRUZ
Practice Address - Street 2:EDIFICIO MEDICO SANTA CRUZ, SUITE 304
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-6910
Practice Address - Country:US
Practice Address - Phone:787-269-3986
Practice Address - Fax:787-995-3775
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12079208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR12079OtherMEDICAL LICENCE
PR12079OtherMEDICAL LICENCE
PR88053Medicare ID - Type Unspecified