Provider Demographics
NPI:1194163873
Name:ACOSTA GONZALEZ, GABRIEL ANTONIO (MD)
Entity type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:ANTONIO
Last Name:ACOSTA GONZALEZ
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:COND TORRE SAN MIGUEL
Mailing Address - Street 2:APT 1503
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-587-9917
Mailing Address - Fax:
Practice Address - Street 1:1660 LOIZA ST
Practice Address - Street 2:MADRID 206
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00911-1867
Practice Address - Country:US
Practice Address - Phone:787-726-5486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR021081207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology