Healthcare Provider Details

I. General information

NPI: 1760642599
Provider Name (Legal Business Name): GRUPO GASTROENTEROLOGICO DEL CARIBE, CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 05/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE SANCHEZ OSORIO
CAROLINA PR
00983-3226
US

IV. Provider business mailing address

E6 VIA LADERAS LA VISTA
SAN JUAN PR
00924-4467
US

V. Phone/Fax

Practice location:
  • Phone: 787-525-0842
  • Fax:
Mailing address:
  • Phone: 787-525-0842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number15951
License Number StatePR

VIII. Authorized Official

Name: DR. JOHANNA BIGIO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-525-0842