Provider Demographics
NPI:1043265374
Name:ALBIZU, GUSTAVO RAFAEL (MD)
Entity type:Individual
Prefix:DR
First Name:GUSTAVO
Middle Name:RAFAEL
Last Name:ALBIZU
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:HC 3 BOX 31902
Mailing Address - Street 2:
Mailing Address - City:MOROVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00687-9031
Mailing Address - Country:US
Mailing Address - Phone:787-862-8844
Mailing Address - Fax:
Practice Address - Street 1:HC 3 BOX 31902
Practice Address - Street 2:
Practice Address - City:MOROVIS
Practice Address - State:PR
Practice Address - Zip Code:00687-9031
Practice Address - Country:US
Practice Address - Phone:787-862-8844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16319208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice