Provider Demographics
NPI:1053374975
Name:ALFONSO, GISHLAINE (MD)
Entity type:Individual
Prefix:DR
First Name:GISHLAINE
Middle Name:
Last Name:ALFONSO
Suffix:
Gender:F
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:CLINICA LAS AMERICAS SUITE 402
Mailing Address - Street 2:ROOSEVELT AVE. #400
Mailing Address - City:HATO REY
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:787-767-2248
Mailing Address - Fax:787-766-3219
Practice Address - Street 1:CLINICA LAS AMERICAS SUITE 402
Practice Address - Street 2:ROOSEVELT AVE. #400
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-767-2248
Practice Address - Fax:787-766-3219
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR99862084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR82382OtherTRIPLE SSS
PR601597OtherMMM
PR601597OtherMMM