Provider Demographics
NPI:1982753737
Name:DIGESTIVE DISEASES ASSOCIATES PSC
Entity Type:Organization
Organization Name:DIGESTIVE DISEASES ASSOCIATES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ADELAIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GELY-MAURAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-723-9595
Mailing Address - Street 1:1431 AVE PONCE DE LEON
Mailing Address - Street 2:SUITE 402
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-4026
Mailing Address - Country:US
Mailing Address - Phone:787-723-9595
Mailing Address - Fax:787-723-8051
Practice Address - Street 1:1431 AVE PONCE DE LEON
Practice Address - Street 2:SUITE 402
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-4026
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:2007-01-10
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9101174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR83965Medicare UPIN