MEDICARE: GASTRO CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician

General Provider Information

NPI Number	:	1821820622
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GASTRO CARE LLC

Provider Business Mailing Address
First Line	:	1485 ASHFORD AVENUE TOWER 1
Second Line	:	802
City	:	SAN JUAN
State	:	PR
Zip	:	00907-1586
Country	:	US
Telephone Number	:	787-565-8210
Fax Number	:

Provider Business Practice Location Address
First Line	:	363 AVE ESCORIAL
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00920-3508
Country	:	US
Telephone Number	:	787-565-8210
Fax Number	:

Authorized Official
Title or Position	:	GASTROENTEROLOGIST
Name	:	DR. EMMANUEL REYES RAMOS
Credential	:	MD
Telephone Number	:	787-565-8210

Provider Enumeration Date	:	08/19/2024
Last Update Date	:	08/19/2024

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