Provider Demographics
NPI:1811936560
Name:BURGOS GANDIA, AUGUSTO CESAR (MD)
Entity type:Individual
Prefix:DR
First Name:AUGUSTO
Middle Name:CESAR
Last Name:BURGOS GANDIA
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 1:763 CALLE DIANA
Mailing Address - Street 2:URB. DOS PINOS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00923-2316
Mailing Address - Country:US
Mailing Address - Phone:787-960-7536
Mailing Address - Fax:
Practice Address - Street 1:763 CALLE DIANA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923-2316
Practice Address - Country:US
Practice Address - Phone:787-960-7536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9515208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF20049Medicare UPIN
0082815Medicare ID - Type Unspecified