Provider Demographics
NPI:1669149126
Name:RODRIGUEZ BENGOCHEA, GABRIELA (MD)
Entity type:Individual
Prefix:
First Name:GABRIELA
Middle Name:
Last Name:RODRIGUEZ BENGOCHEA
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 1:120 AVE LA SIERRA DEL MONTE
Mailing Address - Street 2:APT 5201E, BOX 69
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:786-406-2924
Mailing Address - Fax:
Practice Address - Street 1:120 AVE LA SIERRA DEL MONTE
Practice Address - Street 2:APT 5201E
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:786-406-2924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-24
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR37040207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine