Provider Demographics
NPI:1902854409
Name:CUMBA LLAVONA, GILMARIE (MD)
Entity Type:Individual
Prefix:MRS
First Name:GILMARIE
Middle Name:
Last Name:CUMBA LLAVONA
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 1:349 AVE FELISA R DE GAUTIER
Mailing Address - Street 2:COND. PASEO MONTE 381 APT 1607
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6673
Mailing Address - Country:US
Mailing Address - Phone:787-778-5353
Mailing Address - Fax:787-778-5302
Practice Address - Street 1:INSTITUTO SAN PABLO
Practice Address - Street 2:CALLE SANTA CRUZ SUITE 201
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-7041
Practice Address - Country:US
Practice Address - Phone:787-778-5352
Practice Address - Fax:787-778-5302
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14346208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR21234Medicare ID - Type Unspecified