Healthcare Provider Details

I. General information

NPI: 1376677856
Provider Name (Legal Business Name): GRUPO GASTR DE MANATI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

J23 CALLE ELLIOT VELEZ
MANATI PR
00674-4616
US

IV. Provider business mailing address

J23 CALLE ELLIOT VELEZ
MANATI PR
00674-4616
US

V. Phone/Fax

Practice location:
  • Phone: 787-841-1949
  • Fax: 787-812-0565
Mailing address:
  • Phone: 787-841-1949
  • Fax: 787-812-0565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number12868
License Number StatePR

VIII. Authorized Official

Name: DR. BETTY CHINEA
Title or Position: PRESIDENT
Credential: MD
Phone: 787-841-1949