Provider Demographics
NPI:1720063332
Name:RUIZ DEYA, GILBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:GILBERTO
Middle Name:
Last Name:RUIZ DEYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 AVE TITO CASTRO
Mailing Address - Street 2:STE. 102, PMB 363
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-0200
Mailing Address - Country:US
Mailing Address - Phone:787-284-3333
Mailing Address - Fax:787-284-1722
Practice Address - Street 1:609 AVE TITO CASTRO
Practice Address - Street 2:STE. 102, PMB 363
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-0200
Practice Address - Country:US
Practice Address - Phone:787-284-3333
Practice Address - Fax:787-284-1722
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13510208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0020909Medicare ID - Type Unspecified
PRG23113Medicare UPIN