Healthcare Provider Details

I. General information

NPI: 1386567238
Provider Name (Legal Business Name): PUERTO RICO INTERVENTIONAL ENDOSCOPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

KM 11.7 PR-2
BAYAMON PR
00959
US

IV. Provider business mailing address

1 AVE PALMA REAL APT 2A1
GUAYNABO PR
00969-7201
US

V. Phone/Fax

Practice location:
  • Phone: 787-245-7623
  • Fax:
Mailing address:
  • Phone: 787-245-7623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CARLOS ENRIQUE BERTRAN-RODRIGUEZ
Title or Position: ATTENDING PHYSICIAN
Credential: MD
Phone: 787-245-7623