Provider Demographics
NPI:1720359268
Name:GAZTAMBIDE, NIEVES J (MD)
Entity Type:Individual
Prefix:DR
First Name:NIEVES
Middle Name:J
Last Name:GAZTAMBIDE
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:PO BOX 364007
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-4007
Mailing Address - Country:US
Mailing Address - Phone:787-531-1125
Mailing Address - Fax:787-946-9994
Practice Address - Street 1:500 AVE JESUS T PINERO
Practice Address - Street 2:SUITE 1001
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-4003
Practice Address - Country:US
Practice Address - Phone:787-620-4042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3934208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3934OtherPUERTO RICO BOARD MEDICAL EXAMINERS