Provider Demographics
NPI:1548278260
Name:MONTES BURGOS, GLORIA M (MD)
Entity type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:M
Last Name:MONTES BURGOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:OROCOVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00720-1475
Mailing Address - Country:US
Mailing Address - Phone:787-867-0940
Mailing Address - Fax:787-867-0313
Practice Address - Street 1:AVE LUIS MUNOZ MARIN 16
Practice Address - Street 2:
Practice Address - City:OROCOVIS
Practice Address - State:PR
Practice Address - Zip Code:00720
Practice Address - Country:US
Practice Address - Phone:787-867-0940
Practice Address - Fax:787-867-0313
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6186170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR27472Medicare ID - Type Unspecified
PRD08420Medicare UPIN