Healthcare Provider Details

I. General information

NPI: 1235105453
Provider Name (Legal Business Name): CENTRO DIGESTIVO & HEPATOBILIAR CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 03/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 AVE DEGETAU STE 405 HIMA PLAZA 1
CAGUAS PR
00725-7306
US

IV. Provider business mailing address

PO BOX 6569
CAGUAS PR
00726-6569
US

V. Phone/Fax

Practice location:
  • Phone: 787-744-6590
  • Fax: 787-961-4686
Mailing address:
  • Phone: 787-744-6590
  • Fax: 787-961-4686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GINES A MARTINEZ
Title or Position: PRESIDENTE
Credential: MD
Phone: 787-744-6590