Provider Demographics
NPI:1053550525
Name:GASTROENTEROLOGY & HEPATIC WELLNESS, PSC
Entity type:Organization
Organization Name:GASTROENTEROLOGY & HEPATIC WELLNESS, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FEDERICO
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ-PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-723-9595
Mailing Address - Street 1:42 PARQUE VONDEL
Mailing Address - Street 2:PASEO DEL PARQUE
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-723-9595
Mailing Address - Fax:787-723-8051
Practice Address - Street 1:1431 PONCE DE LEON
Practice Address - Street 2:SUITE 402
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-4033
Practice Address - Country:US
Practice Address - Phone:787-723-9595
Practice Address - Fax:787-723-8051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-06
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9101261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF31659Medicare UPIN