1063191914 NPI number — GAMA MULTISPECIALTY GROUP LLC

Table of content: (NPI 1063191914)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063191914 NPI number — GAMA MULTISPECIALTY GROUP LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GAMA MULTISPECIALTY GROUP LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063191914
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6676
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAYAGUEZ
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00681-6676
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 2 KM 133.5 EDIF CENTERPLEX SUITE 307-A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AGUADA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-376-1086
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/17/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RODRIGUEZ CHERVONI
Authorized Official First Name:
JOANNA
Authorized Official Middle Name:
Authorized Official Title or Position:
AGENTE RESIDENTE
Authorized Official Telephone Number:
787-376-1806

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RE0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)