Provider Demographics
NPI:1962491258
Name:SASTRE, GLADYS C (MD)
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:C
Last Name:SASTRE
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 270231
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00928-3031
Mailing Address - Country:US
Mailing Address - Phone:787-731-7717
Mailing Address - Fax:
Practice Address - Street 1:369 AVE DE DIEGO
Practice Address - Street 2:STE 401 TORRE SAN FRANCISCO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923-3003
Practice Address - Country:US
Practice Address - Phone:787-753-8778
Practice Address - Fax:787-731-7717
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13011207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H07318Medicare UPIN
20001Medicare ID - Type Unspecified