Provider Demographics
NPI:1861868747
Name:OTERO GIBOYEAUX, GILBERT (MS)
Entity type:Individual
Prefix:
First Name:GILBERT
Middle Name:
Last Name:OTERO GIBOYEAUX
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:JARDIN DORADO
Mailing Address - Street 2:CALLE PERSA E11 21273
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646
Mailing Address - Country:US
Mailing Address - Phone:787-619-3050
Mailing Address - Fax:
Practice Address - Street 1:38A CARR 696
Practice Address - Street 2:
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-5843
Practice Address - Country:US
Practice Address - Phone:787-619-3050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-14
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3057235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist