Provider Demographics
NPI:1245231497
Name:GASTRO MED DEL SUR, P.S.C.
Entity Type:Organization
Organization Name:GASTRO MED DEL SUR, P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-290-2948
Mailing Address - Street 1:909 AVE. TITO CASTRO SUITE 518
Mailing Address - Street 2:TORRE MEDICA SAN LUCAS
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-4721
Mailing Address - Country:US
Mailing Address - Phone:787-290-2948
Mailing Address - Fax:787-841-4832
Practice Address - Street 1:909 AVE. TITO CASTRO SUITE 518
Practice Address - Street 2:TORRE MEDICA SAN LUCAS
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-4721
Practice Address - Country:US
Practice Address - Phone:787-290-2948
Practice Address - Fax:787-841-4832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8042174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE63384Medicare UPIN
PR81900Medicare ID - Type UnspecifiedMEDICARE PROVIDER