Provider Demographics
NPI:1518994706
Name:INSTITUTO DE GASTROENTEROLOGIA ENDOSCOPIA DIGESTIVA
Entity Type:Organization
Organization Name:INSTITUTO DE GASTROENTEROLOGIA ENDOSCOPIA DIGESTIVA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILIO
Authorized Official - Middle Name:RAFAEL
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-746-5993
Mailing Address - Street 1:201 AVE. GAUTIER BENITEZ
Mailing Address - Street 2:TERCER PISO OFICINA 303
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-746-5993
Mailing Address - Fax:787-746-5993
Practice Address - Street 1:201 AVE. GAUTIER BENITEZ
Practice Address - Street 2:TERCER PISO OFICINA 303
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-746-5993
Practice Address - Fax:787-746-5993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0085023Medicare PIN
PR0085006Medicare PIN