Healthcare Provider Details

I. General information

NPI: 1144530916
Provider Name (Legal Business Name): ZOM PROFESSIONAL GASTROENTEROLOGY, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2010
Last Update Date: 12/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE TURQUESA, #28 SENDEROS DE MONTEHIEDRA
SAN JUAN PR
00926
US

IV. Provider business mailing address

PO BOX 364584
SAN JUAN PR
00936-4584
US

V. Phone/Fax

Practice location:
  • Phone: 787-963-0550
  • Fax: 787-963-0550
Mailing address:
  • Phone: 787-318-6197
  • Fax: 787-963-0550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number15,931
License Number StatePR

VIII. Authorized Official

Name: DR. ZHAMARIE ORTIZ MERCADO
Title or Position: MEDICO
Credential: MD
Phone: 787-318-6197