Provider Demographics
NPI:1437339462
Name:CLINICA DE GASTROENTEROLOGIA DR. RAFAEL PEREZ BARTOLOMEI CSP
Entity Type:Organization
Organization Name:CLINICA DE GASTROENTEROLOGIA DR. RAFAEL PEREZ BARTOLOMEI CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:PEREZ-BARTOLOMEI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-884-4872
Mailing Address - Street 1:B40 CALLE ELLIOT VELEZ
Mailing Address - Street 2:URB ATENAS
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-4615
Mailing Address - Country:US
Mailing Address - Phone:787-884-4872
Mailing Address - Fax:787-884-4873
Practice Address - Street 1:B40 CALLE ELLIOT VELEZ
Practice Address - Street 2:URB ATENAS
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-4615
Practice Address - Country:US
Practice Address - Phone:787-884-4872
Practice Address - Fax:787-884-4873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14750207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0085384OtherMEDICARE PROVIDER TRANSACTION ACCESS NUMBER (PTAN)
PR14750OtherMEDICAL LICENSE