Provider Demographics
NPI:1447589247
Name:ACL GASTRO PSC
Entity Type:Organization
Organization Name:ACL GASTRO PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ-LOUBRIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-479-2004
Mailing Address - Street 1:LA FLORESTA 1000 CARR. 831 APT. 641
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956
Mailing Address - Country:US
Mailing Address - Phone:787-479-2004
Mailing Address - Fax:
Practice Address - Street 1:HOSPITAL METROPOLITANO 1785 CARR. 21 URB. LAS LOMAS
Practice Address - Street 2:SUITE 208
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-220-4435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15922207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty