Healthcare Provider Details

I. General information

NPI: 1265468805
Provider Name (Legal Business Name): PONCE GASTROENTEROLOGY SOCIETY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SANTA MARIA MEDICAL 450 C/FERROCARRIL, STE. 210
PONCE PR
00717-1105
US

IV. Provider business mailing address

450 FERROCARRIL STA. MARIA MEDICAL STE. 210
PONCE PR
00717-1105
US

V. Phone/Fax

Practice location:
  • Phone: 787-840-0100
  • Fax: 787-841-6849
Mailing address:
  • Phone: 787-840-0100
  • Fax: 787-841-6849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number7296
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number4589
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number6905
License Number StatePR

VIII. Authorized Official

Name: DR. LUIS MARTINEZ-SIERRA
Title or Position: PRESIDENT
Credential: MD
Phone: 787-840-5042