Healthcare Provider Details

I. General information

NPI: 1538437082
Provider Name (Legal Business Name): PUERTO RICO GASTRO, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2011
Last Update Date: 12/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 N CALLE RAMON E. BETANCES
MAYAGUEZ PR
00680
US

IV. Provider business mailing address

PO BOX 1936
MAYAGUEZ PR
00681-1936
US

V. Phone/Fax

Practice location:
  • Phone: 787-265-7555
  • Fax: 787-833-4191
Mailing address:
  • Phone: 787-265-7555
  • Fax: 787-833-4191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number8519
License Number StatePR

VIII. Authorized Official

Name: EDWARD S SINGH
Title or Position: PRESIDENT
Credential: MD
Phone: 787-265-7555