Provider Demographics
NPI:1598416067
Name:GASTRO CLASS LLC
Entity Type:Organization
Organization Name:GASTRO CLASS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WALISBETH
Authorized Official - Middle Name:
Authorized Official - Last Name:CLASS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-404-7820
Mailing Address - Street 1:D14 CALLE PARKSIDE 6 APT 906
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968-3338
Mailing Address - Country:US
Mailing Address - Phone:787-404-7820
Mailing Address - Fax:
Practice Address - Street 1:239 ARTERIAL HOSTOS AVE STE 305
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-1476
Practice Address - Country:US
Practice Address - Phone:939-236-3239
Practice Address - Fax:939-236-3239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-15
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty