Healthcare Provider Details

I. General information

NPI: 1720115249
Provider Name (Legal Business Name): GASTROCORP & ASSOC., PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 03/07/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

A7 AVE DEGETAU URB BONNEVILLE TERRACE
CAGUAS PR
00725
US

IV. Provider business mailing address

PO BOX 8008
CAGUAS PR
00726-8008
US

V. Phone/Fax

Practice location:
  • Phone: 787-258-3245
  • Fax: 787-761-5764
Mailing address:
  • Phone: 787-258-3245
  • Fax: 787-744-1120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number11831
License Number StatePR

VIII. Authorized Official

Name: DR. HARRY R RUIZ FIGUEROA
Title or Position: MIDCO
Credential: MD
Phone: 787-258-3245