Healthcare Provider Details

I. General information

NPI: 1063191914
Provider Name (Legal Business Name): GAMA MULTISPECIALTY GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 2 KM 133.5 EDIF CENTERPLEX SUITE 307-A
AGUADA PR
00602
US

IV. Provider business mailing address

PO BOX 6676
MAYAGUEZ PR
00681-6676
US

V. Phone/Fax

Practice location:
  • Phone: 787-376-1086
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: JOANNA RODRIGUEZ CHERVONI
Title or Position: AGENTE RESIDENTE
Credential:
Phone: 787-376-1806