Provider Demographics
NPI:1487035390
Name:SAN PABLO GASTROENTEROLOGY PSC
Entity Type:Organization
Organization Name:SAN PABLO GASTROENTEROLOGY PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:JUAN
Authorized Official - Last Name:MARRERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-995-0500
Mailing Address - Street 1:425 CARR 693
Mailing Address - Street 2:PMB 152
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-4816
Mailing Address - Country:US
Mailing Address - Phone:787-995-0500
Mailing Address - Fax:
Practice Address - Street 1:28 SANTA CRUZ STREET
Practice Address - Street 2:TORRE SAN PABLO SUITE 202-A
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-995-0500
Practice Address - Fax:787-785-0063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16988207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty