Provider Demographics
NPI:1912373432
Name:GASTRO MED DE PUERTO RICO PSC
Entity Type:Organization
Organization Name:GASTRO MED DE PUERTO RICO PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GINES
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-691-1201
Mailing Address - Street 1:PO BOX 6600
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-6600
Mailing Address - Country:US
Mailing Address - Phone:787-691-1201
Mailing Address - Fax:
Practice Address - Street 1:HIMA PLAZA 1
Practice Address - Street 2:500 AVE DEGETAU STE 405
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-7301
Practice Address - Country:US
Practice Address - Phone:787-744-6590
Practice Address - Fax:787-961-4686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8842261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty