Provider Demographics
NPI:1194957845
Name:LAABES GONZALEZ, GUSTAVO ABDIEL (MD)
Entity type:Individual
Prefix:DR
First Name:GUSTAVO
Middle Name:ABDIEL
Last Name:LAABES GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:510 CALLE FRANCISCO CAMACHO APT 1104
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-2442
Mailing Address - Country:US
Mailing Address - Phone:787-585-7580
Mailing Address - Fax:787-868-8811
Practice Address - Street 1:CARR 417 KM 2.7
Practice Address - Street 2:BO MALPASO
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-9857
Practice Address - Country:US
Practice Address - Phone:787-868-8811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-13
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17717208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRFA598ZMedicare PIN