Provider Demographics
NPI:1760030449
Name:VR GASTRO PSC
Entity Type:Organization
Organization Name:VR GASTRO PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:E
Authorized Official - Last Name:OSORIO MANOTAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-780-4297
Mailing Address - Street 1:CIUDAD JARDIN
Mailing Address - Street 2:443 PASEO DORADO
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729
Mailing Address - Country:US
Mailing Address - Phone:787-780-4297
Mailing Address - Fax:787-798-3110
Practice Address - Street 1:PASEO SAN PABLO #100
Practice Address - Street 2:EDIF. ARTURO CADILLA SUITE 501
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-780-4297
Practice Address - Fax:787-798-3110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR020939OtherLICENCE NUMBER