Provider Demographics
NPI:1760724777
Name:SANTOS-DELGADO, GABRIEL (OD)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:SANTOS-DELGADO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CARR 3 KM 43.3
Mailing Address - Street 2:PLAZA FAJARDO, LOCAL 125
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738
Mailing Address - Country:US
Mailing Address - Phone:787-801-5896
Mailing Address - Fax:
Practice Address - Street 1:PLAZA FAJARDO CARR 3 KM 43.3
Practice Address - Street 2:LOCAL 125
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-801-5896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-18
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002210152W00000X
MDTA2343152W00000X
PR00726152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR038044400Medicaid