1760645105 NPI number — GASTROENTEROLOGIA AVANZADA DEL CARIBE,C.S.P.

Table of content: (NPI 1760645105)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760645105 NPI number — GASTROENTEROLOGIA AVANZADA DEL CARIBE,C.S.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GASTROENTEROLOGIA AVANZADA DEL CARIBE,C.S.P.
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:
1760645105
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3146
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:
00681-3146
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-265-4250
Provider Business Mailing Address Fax Number:
787-265-4290

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
55 EAST DE DIEGO STREET, C.P.R. PROF. BLDG.
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
MAYAGUEZ
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00680
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-265-4250
Provider Business Practice Location Address Fax Number:
787-265-4290
Provider Enumeration Date:
07/07/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LOPEZ
Authorized Official First Name:
ANA
Authorized Official Middle Name:
MARIA
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
787-265-4250

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  12853 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0089618 . This is a "MEDICARE & TRIPLE S" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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