Healthcare Provider Details

I. General information

NPI: 1912373432
Provider Name (Legal Business Name): GASTRO MED DE PUERTO RICO PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2015
Last Update Date: 08/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HIMA PLAZA 1 500 AVE DEGETAU STE 405
CAGUAS PR
00725-7301
US

IV. Provider business mailing address

PO BOX 6600
CAGUAS PR
00726-6600
US

V. Phone/Fax

Practice location:
  • Phone: 787-744-6590
  • Fax: 787-961-4686
Mailing address:
  • Phone: 787-691-1201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number8842
License Number StatePR

VIII. Authorized Official

Name: DR. GINES A MARTINEZ
Title or Position: PRESIDENT
Credential: MD
Phone: 787-691-1201