Provider Demographics
NPI:1851494751
Name:RODRIGUEZ-GOTAY, GLADYS (MD)
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:
Last Name:RODRIGUEZ-GOTAY
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 1:53 CALLE BALDORIOTY N
Mailing Address - Street 2:BOX 2013
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-3219
Mailing Address - Country:US
Mailing Address - Phone:787-735-6330
Mailing Address - Fax:
Practice Address - Street 1:53 CALLE BALDORIOTY N
Practice Address - Street 2:BOX 2013
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705-3219
Practice Address - Country:US
Practice Address - Phone:787-735-6330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7027261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR28871Medicare ID - Type Unspecified
PRC79790Medicare UPIN