1114558640 NPI number — GASTROENTEROLOGOS ASOCIADOS DE PUERTO RICO PSC

Table of content: (NPI 1114558640)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114558640 NPI number — GASTROENTEROLOGOS ASOCIADOS DE PUERTO RICO PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GASTROENTEROLOGOS ASOCIADOS DE PUERTO RICO PSC
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:
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Provider Other Name Suffix Text:
Provider Other Credential Text:
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NPI Number Information

NPI Number:
1114558640
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PMB 198 1357 AVE. ASHFORD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00907-1400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-625-2489
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE 2 J-13
Provider Second Line Business Practice Location Address:
EXTENSION HERMANAS DAVILA
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00959-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-625-2489
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/03/2020

Additional Information

Authorized Official

Authorized Official Last Name:
ZAMOT CARMONA
Authorized Official First Name:
ALBERTO
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-299-4972

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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