Provider Demographics
NPI:1386423325
Name:HERNANDEZ GOMEZ, GILBERTO LUIS SR
Entity type:Individual
Prefix:
First Name:GILBERTO
Middle Name:LUIS
Last Name:HERNANDEZ GOMEZ
Suffix:SR
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:PO BOX 1056
Mailing Address - Street 2:
Mailing Address - City:UTUADO
Mailing Address - State:PR
Mailing Address - Zip Code:00641-1056
Mailing Address - Country:US
Mailing Address - Phone:787-385-2801
Mailing Address - Fax:
Practice Address - Street 1:33 CALLE DR CUETO
Practice Address - Street 2:
Practice Address - City:UTUADO
Practice Address - State:PR
Practice Address - Zip Code:00641-2887
Practice Address - Country:US
Practice Address - Phone:787-385-2801
Practice Address - Fax:787-919-0179
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-28
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR87152163W00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No163W00000XNursing Service ProvidersRegistered Nurse