Provider Demographics
NPI:1972651693
Name:CENTRO DE GASTROENTEROLOGIA PEDIATRICA DEL OESTE
Entity Type:Organization
Organization Name:CENTRO DE GASTROENTEROLOGIA PEDIATRICA DEL OESTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-805-6868
Mailing Address - Street 1:PO BOX 3224
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-3224
Mailing Address - Country:US
Mailing Address - Phone:787-805-5830
Mailing Address - Fax:787-805-6430
Practice Address - Street 1:55 CALLE DR BASORA N
Practice Address - Street 2:OFFICE 212
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4810
Practice Address - Country:US
Practice Address - Phone:787-805-5830
Practice Address - Fax:787-805-6430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR106202080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric GastroenterologyGroup - Single Specialty