Provider Demographics
NPI:1174546576
Name:ALBAN, GLADYS MYRIAM (MD)
Entity type:Individual
Prefix:DR
First Name:GLADYS
Middle Name:MYRIAM
Last Name:ALBAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 398
Mailing Address - Street 2:
Mailing Address - City:AGUIRRE
Mailing Address - State:PR
Mailing Address - Zip Code:00704-0398
Mailing Address - Country:US
Mailing Address - Phone:787-686-7751
Mailing Address - Fax:787-686-7749
Practice Address - Street 1:CARR. # 3 KM. 151.4
Practice Address - Street 2:BO. COQUI
Practice Address - City:AGUIRRE
Practice Address - State:PR
Practice Address - Zip Code:00704
Practice Address - Country:US
Practice Address - Phone:787-853-2607
Practice Address - Fax:787-853-0557
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14251207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRM220OtherMENONITA
PR400-3430OtherMEDICARE Y MUCHO MAS
PRA 843OtherFIRST MEDICAL
PR4550-5OtherPROSSAM
PR23456OtherTRIPLE - S
PR7850025OtherHUMANA GOLD PLUS
PR04466OtherAMERICAN HEALTH, INC.
PR7850025OtherHUMANA GOLD PLUS
PR04466OtherAMERICAN HEALTH, INC.