Provider Demographics
NPI:1770960163
Name:GIL DE RUBIO CRUZ, PEDRO DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:DAVID
Last Name:GIL DE RUBIO CRUZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43-16 35TH STREET
Mailing Address - Street 2:VILLA CAROLINA III
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985-5672
Mailing Address - Country:US
Mailing Address - Phone:787-381-7418
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 3 KM. 8.3
Practice Address - Street 2:AVE 65 DE INFANTERIA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00984
Practice Address - Country:US
Practice Address - Phone:787-757-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-05
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22150207R00000X, 207RG0300X, 207R00000X
PR390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRDM-30780-1OtherPUERTO RICO DEPARTMENT OF HEALTH CONTROLLED SUBSTANCES
418986OtherTHE AMERICAN BOARD OF INTERNAL MEDICINE
PR22150OtherPUERTO RICO MEDICAL DISCIPLINE AND LICENSURE BOARD
PR039035300Medicaid
CT67342OtherCONNECTICUT DEPARTMENT OF PUBLIC HEALTH