Healthcare Provider Details

I. General information

NPI: 1023734373
Provider Name (Legal Business Name): G & G MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2022
Last Update Date: 10/18/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. 188 KM 1.5 BO. SAN ISIDRO
CANOVANAS PR
00729-3998
US

IV. Provider business mailing address

PO BOX 155
RIO GRANDE PR
00745-0155
US

V. Phone/Fax

Practice location:
  • Phone: 787-957-2020
  • Fax:
Mailing address:
  • Phone: 787-957-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. GERT H WANDERSLEBEN
Title or Position: PRESIDENT
Credential: MD
Phone: 787-957-2020