Provider Demographics
NPI:1871233288
Name:IGLESIAS PEDIATRIC GASTRO CLINIC LLC
Entity Type:Organization
Organization Name:IGLESIAS PEDIATRIC GASTRO CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IVONNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:IGLESIAS ESCABI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:939-218-6135
Mailing Address - Street 1:BOSQUE DEL LAGO
Mailing Address - Street 2:BC26 PLAZA 8
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976
Mailing Address - Country:US
Mailing Address - Phone:939-218-6135
Mailing Address - Fax:
Practice Address - Street 1:BO SABALOS CARR 2
Practice Address - Street 2:410 AVE HOSTOS
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682
Practice Address - Country:US
Practice Address - Phone:787-652-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric GastroenterologyGroup - Single Specialty