Provider Demographics
NPI:1316394612
Name:CENTRO DE GASTROENTEROLOGIA
Entity Type:Organization
Organization Name:CENTRO DE GASTROENTEROLOGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D
Authorized Official - Prefix:MR
Authorized Official - First Name:MELVYN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ACOSTA FEBO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-777-8212
Mailing Address - Street 1:576 AVE CESAR GONZALEZ SUITE 405
Mailing Address - Street 2:DORAL BANK CENTER
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919
Mailing Address - Country:US
Mailing Address - Phone:787-777-8202
Mailing Address - Fax:787-777-8204
Practice Address - Street 1:AVE CESAR GONZALEZ 405
Practice Address - Street 2:DORAL BANK CENTER 576
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00919
Practice Address - Country:US
Practice Address - Phone:787-777-8202
Practice Address - Fax:787-777-8204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty