Provider Demographics
NPI:1639206667
Name:CENTRO GASTROENTEROLOGIA AVANZADA DEL NORTE CSP
Entity Type:Organization
Organization Name:CENTRO GASTROENTEROLOGIA AVANZADA DEL NORTE CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MIDICO
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:L
Authorized Official - Last Name:CORTES RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-778-0632
Mailing Address - Street 1:333 DORADO BEACH EAST
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-2217
Mailing Address - Country:US
Mailing Address - Phone:787-778-0632
Mailing Address - Fax:787-778-3720
Practice Address - Street 1:INSTITUTO SAN PABLO SUITE 502
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-778-0632
Practice Address - Fax:787-778-3720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13909207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR79706Medicare PIN
PRH04170Medicare UPIN
PR0079706Medicare PIN