Provider Demographics
NPI:1760645105
Name:GASTROENTEROLOGIA AVANZADA DEL CARIBE,C.S.P.
Entity Type:Organization
Organization Name:GASTROENTEROLOGIA AVANZADA DEL CARIBE,C.S.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-265-4250
Mailing Address - Street 1:PO BOX 3146
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-3146
Mailing Address - Country:US
Mailing Address - Phone:787-265-4250
Mailing Address - Fax:787-265-4290
Practice Address - Street 1:55 EAST DE DIEGO STREET, C.P.R. PROF. BLDG.
Practice Address - Street 2:SUITE 104
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-265-4250
Practice Address - Fax:787-265-4290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-07
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12853207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0089618OtherMEDICARE & TRIPLE S
PRCQ536AMedicare PIN
PRFC93568Medicare UPIN