Provider Demographics
NPI:1053427443
Name:SOLIVAN ACOSTA, GILBERTO A (MD)
Entity type:Individual
Prefix:DR
First Name:GILBERTO
Middle Name:A
Last Name:SOLIVAN ACOSTA
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 1:440 CALLE SAN JULIAN
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-4217
Mailing Address - Country:US
Mailing Address - Phone:787-685-5895
Mailing Address - Fax:787-789-1921
Practice Address - Street 1:440 SAN JULIAN
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-764-3024
Practice Address - Fax:787-789-1921
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16505207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA13631Medicare ID - Type Unspecified