Provider Demographics
NPI:1518338193
Name:METROPOLITAN OTORHINOLARYNGOLOGY GROUP, CSP
Entity Type:Organization
Organization Name:METROPOLITAN OTORHINOLARYNGOLOGY GROUP, CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GUSTAVO
Authorized Official - Middle Name:A
Authorized Official - Last Name:MELERO GIGANTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-781-0644
Mailing Address - Street 1:300 LAS FLORES MONTEHIEDRA
Mailing Address - Street 2:BOX 643
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-781-0644
Mailing Address - Fax:787-781-5923
Practice Address - Street 1:1785 CARR 21
Practice Address - Street 2:COND. TORRE DEL METROPOLITAN OFICINA 309
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-781-0644
Practice Address - Fax:787-781-5923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13177207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty