Provider Demographics
NPI:1912426008
Name:GOTAY GUZMAN, ABELARDO
Entity Type:Individual
Prefix:
First Name:ABELARDO
Middle Name:
Last Name:GOTAY GUZMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CALLE JOSE JULIAN ACOSTA
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-5628
Mailing Address - Country:US
Mailing Address - Phone:787-244-6831
Mailing Address - Fax:
Practice Address - Street 1:600 CALLE DR HERNAN CORTES STE 201
Practice Address - Street 2:
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00950-5001
Practice Address - Country:US
Practice Address - Phone:787-710-2532
Practice Address - Fax:939-202-7294
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-11
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0243133N00000X
PR2043133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2043OtherOFFICE OF REGULATION AND CERTIFICATION OF HEATLH PROFESSIONALES OF PR