Provider Demographics
NPI:1356692057
Name:A & S GASTROINTESTINAL DISEASES CLINICS PSC
Entity type:Organization
Organization Name:A & S GASTROINTESTINAL DISEASES CLINICS PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:ANTUNEZ GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-765-6554
Mailing Address - Street 1:PMB 311 NUM 35 JUAN C BORBON SUITE 67
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-0000
Mailing Address - Country:US
Mailing Address - Phone:787-765-6554
Mailing Address - Fax:787-283-3476
Practice Address - Street 1:35 CALLE JUAN C BORBON STE 67
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-5375
Practice Address - Country:US
Practice Address - Phone:787-765-6554
Practice Address - Fax:787-283-3476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-21
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13434207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty