Healthcare Provider Details

I. General information

NPI: 1336059989
Provider Name (Legal Business Name): PR GASTRO CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25-123 AVENIDA ROBERTO CLEMENTE
CAROLINA PR
00985
US

IV. Provider business mailing address

15 CALLE TAFT APT 802
SAN JUAN PR
00911-1283
US

V. Phone/Fax

Practice location:
  • Phone: 939-236-6016
  • Fax:
Mailing address:
  • Phone: 787-354-3710
  • 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. JON A TORRES
Title or Position: OWNER
Credential: MD
Phone: 787-354-3710