Provider Demographics
NPI:1780854901
Name:GASTROENTEROLOGY (DIGESTIVE) AND NUTRITION CENTER, PSC
Entity Type:Organization
Organization Name:GASTROENTEROLOGY (DIGESTIVE) AND NUTRITION CENTER, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:CRUZ-CORREA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:787-786-3110
Mailing Address - Street 1:STA. CRUZ ST. #73 EDIFICIO MEDICO SANTA CRUZ
Mailing Address - Street 2:SUITE 403
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961
Mailing Address - Country:US
Mailing Address - Phone:787-786-3110
Mailing Address - Fax:787-786-3120
Practice Address - Street 1:STA. CRUZ ST. #73 EDIFICIO MEDICO SANTA CRUZ
Practice Address - Street 2:SUITE 403
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-786-3110
Practice Address - Fax:787-786-3120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12414174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty