Provider Demographics
NPI:1215074331
Name:GAZTAMBIDE, JAPHET (MD)
Entity type:Individual
Prefix:
First Name:JAPHET
Middle Name:
Last Name:GAZTAMBIDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:P O BOX 7004
Mailing Address - Street 2:PONCE SCHOOL OF MEDICINE
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-7004
Mailing Address - Country:US
Mailing Address - Phone:787-840-2575
Mailing Address - Fax:787-840-8391
Practice Address - Street 1:CENTRO DE SALUD CONDUCTUAL DE AGUADILLA
Practice Address - Street 2:AVE. KENNEDY # 15
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-840-2575
Practice Address - Fax:787-840-8391
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR119402084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry