Provider Demographics
NPI:1265572275
Name:ALLENDE, GERARDO JOSE ROBERTO (MD)
Entity type:Individual
Prefix:DR
First Name:GERARDO JOSE
Middle Name:ROBERTO
Last Name:ALLENDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GERARDO
Other - Middle Name:J
Other - Last Name:ALLENDE SANTOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 878
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745-0878
Mailing Address - Country:US
Mailing Address - Phone:787-636-6656
Mailing Address - Fax:
Practice Address - Street 1:AVE. GARCIA DE LA NOCEDA A-3 VILLAS DE RIO GRANDE
Practice Address - Street 2:
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745-0878
Practice Address - Country:US
Practice Address - Phone:787-636-6656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11208208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0083402Medicare ID - Type Unspecified
PRE42969Medicare UPIN