Healthcare Provider Details

I. General information

NPI: 1053550525
Provider Name (Legal Business Name): GASTROENTEROLOGY & HEPATIC WELLNESS, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2009
Last Update Date: 02/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1431 PONCE DE LEON SUITE 402
SAN JUAN PR
00907-4033
US

IV. Provider business mailing address

42 PARQUE VONDEL PASEO DEL PARQUE
SAN JUAN PR
00926
US

V. Phone/Fax

Practice location:
  • Phone: 787-723-9595
  • Fax: 787-723-8051
Mailing address:
  • Phone: 787-723-9595
  • Fax: 787-723-8051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number9101
License Number StatePR

VIII. Authorized Official

Name: DR. FEDERICO RODRIGUEZ-PEREZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-723-9595