Provider Demographics
NPI:1902893191
Name:GAYOL, PRISCILLA III (MD)
Entity Type:Individual
Prefix:DR
First Name:PRISCILLA
Middle Name:
Last Name:GAYOL
Suffix:III
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PRISCILLA
Other - Middle Name:
Other - Last Name:GAYOL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:C12 DOMENECH
Mailing Address - Street 2:SIERRA BERDECIA
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-6225
Mailing Address - Country:US
Mailing Address - Phone:787-760-6604
Mailing Address - Fax:787-790-4010
Practice Address - Street 1:28 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976-5933
Practice Address - Country:US
Practice Address - Phone:787-760-6604
Practice Address - Fax:787-292-0130
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15853208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR15853OtherCERTIFICACION