Healthcare Provider Details

I. General information

NPI: 1992790133
Provider Name (Legal Business Name): GASTROENTEROLOGY CENTRE C.S.P.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 08/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

A3 AVE PEDRO ALBIZU CAMPOS VILLA ROSA III
GUAYAMA PR
00784-6407
US

IV. Provider business mailing address

A3 AVE PEDRO ALBIZU CAMPOS VILLA ROSA III
GUAYAMA PR
00784-6407
US

V. Phone/Fax

Practice location:
  • Phone: 787-866-3675
  • Fax: 787-866-1249
Mailing address:
  • Phone: 787-866-3675
  • Fax: 787-866-1249

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. RUBEN LUGO ZAMBRANA
Title or Position: PRESIDENT
Credential: MD
Phone: 787-866-3675