Provider Demographics
NPI:1346125622
Name:PABON SAN INOCENCIO, GEDALIS
Entity type:Individual
Prefix:
First Name:GEDALIS
Middle Name:
Last Name:PABON SAN INOCENCIO
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB COUNTRY CLUB
Mailing Address - Street 2:OB10 CALLE 502 4TA EXT
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00982
Mailing Address - Country:US
Mailing Address - Phone:787-429-5059
Mailing Address - Fax:
Practice Address - Street 1:BO. MACHUELO, EDIFICIO SAN LUCAS #2
Practice Address - Street 2:CARR. 14
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00931
Practice Address - Country:US
Practice Address - Phone:787-429-5059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-07
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist