1811618077 NPI number — SV GASTROENTEROLOGY LLC

Table of content: (NPI 1811618077)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811618077 NPI number — SV GASTROENTEROLOGY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SV GASTROENTEROLOGY 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:
1811618077
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
URB. OLYMPIC COURT
Provider Second Line Business Mailing Address:
153-A4 CALLE ANTIOQUIA
Provider Business Mailing Address City Name:
LAS PIEDRAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00771-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-475-0388
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
874 FERNANDEZ JUNCOS AVENUE
Provider Second Line Business Practice Location Address:
EDIFICIO JESUS T PINEIRO
Provider Business Practice Location Address City Name:
CAROLINA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00979-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-626-3322
Provider Business Practice Location Address Fax Number:
787-626-0472
Provider Enumeration Date:
09/07/2022

Additional Information

Authorized Official

Authorized Official Last Name:
VELAZQUEZ
Authorized Official First Name:
STEPHANIE
Authorized Official Middle Name:
JANICE
Authorized Official Title or Position:
SOLE OWNER
Authorized Official Telephone Number:
787-475-0388

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)





Copyright © 2007-2025 www.npivalidator.com