Provider Demographics
NPI:1407289473
Name:ADVANCED GASTROENTEROLOGY CENTER
Entity Type:Organization
Organization Name:ADVANCED GASTROENTEROLOGY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GASTROENTEROLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:HIRAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-529-1699
Mailing Address - Street 1:PO BOX 1443
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-1443
Mailing Address - Country:US
Mailing Address - Phone:787-679-8144
Mailing Address - Fax:
Practice Address - Street 1:CARR 115 KM 24.5
Practice Address - Street 2:BO ASOMANTE
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602
Practice Address - Country:US
Practice Address - Phone:787-679-8144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
17586261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy