Healthcare Provider Details

I. General information

NPI: 1629063151
Provider Name (Legal Business Name): INSTITUTO DE GASTROENTEROLOGIA DE PR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 12/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 AVE FD ROOSEVELT CLINICA LAS AMERICAS SUITE 206
SAN JUAN PR
00918-2103
US

IV. Provider business mailing address

400 AVE FD ROOSEVELT CLINICA LAS AMERICAS SUITE 206
SAN JUAN PR
00918-2103
US

V. Phone/Fax

Practice location:
  • Phone: 787-764-8787
  • Fax: 787-250-1029
Mailing address:
  • Phone: 787-764-8787
  • Fax: 787-250-1029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number155
License Number StatePR

VIII. Authorized Official

Name: DR. FERNANDO RAMOS
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 787-764-8787