Healthcare Provider Details

I. General information

NPI: 1063843035
Provider Name (Legal Business Name): ASHFORD GASTROENTEROLOGY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2013
Last Update Date: 12/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 CALLE WASHINGTON STE 506
SAN JUAN PR
00907-1521
US

IV. Provider business mailing address

29 CALLE WASHINGTON 506
SAN JUAN PR
00907-1510
US

V. Phone/Fax

Practice location:
  • Phone: 787-725-4705
  • Fax: 787-725-4705
Mailing address:
  • Phone: 787-725-4705
  • Fax: 787-725-4705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. WILFREDO PAGANI
Title or Position: DOCTOR
Credential: 9146
Phone: 787-725-7405