Basic Information
| Provider Information | |||||||||
| NPI: | 1770960163 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GIL DE RUBIO CRUZ | ||||||||
| FirstName: | PEDRO | ||||||||
| MiddleName: | DAVID | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 43-16 35TH STREET | ||||||||
| Address2: | VILLA CAROLINA III | ||||||||
| City: | CAROLINA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009855672 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7873817418 | ||||||||
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| Practice Location | |||||||||
| Address1: | UNIVERSITY DISTRICT HOSPITAL PR MEDICAL CENTER | ||||||||
| Address2: | |||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877540101 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2015 | ||||||||
| LastUpdateDate: | 06/01/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 22150 | PR | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | DM-30780-1 | 01 | PR | PUERTO RICO DEPARTMENT OF HEALTH CONTROLLED SUBSTANCES | OTHER | 22150 | 01 | PR | PUERTO RICO MEDICAL DISCIPLINE AND LICENSURE BOARD | OTHER | 418986 | 01 | THE AMERICAN BOARD OF INTERNAL MEDICINE | OTHER | 039035300 | 05 | PR | MEDICAID |