Healthcare Provider Details

I. General information

NPI: 1164720975
Provider Name (Legal Business Name): ADVANCED GASTROENTEROLOGY, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2011
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 CALLE SANTA CRUZ TORRE SAN PABLO SUITE 803B
BAYAMON PR
00961-7031
US

IV. Provider business mailing address

68 CALLE SANTA CRUZ TORRE SAN PABLO SUITE 803B
BAYAMON PR
00961-7031
US

V. Phone/Fax

Practice location:
  • Phone: 787-288-6998
  • Fax:
Mailing address:
  • Phone: 787-288-6998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RAMON M RULLAN
Title or Position: PRESIDENT
Credential: MD
Phone: 787-288-6998