Healthcare Provider Details

I. General information

NPI: 1649157181
Provider Name (Legal Business Name): MARIA GONZALEZ ECHEANDIA GASTROPEDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2025
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3006 AVE EMILIO FAGOT
PONCE PR
00716-3601
US

IV. Provider business mailing address

3006 AVE EMILIO FAGOT
PONCE PR
00716-3601
US

V. Phone/Fax

Practice location:
  • Phone: 787-455-4592
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARIA CRISTINA GONZALEZ
Title or Position: MD
Credential: MD
Phone: 787-455-4592