Healthcare Provider Details

I. General information

NPI: 1497997555
Provider Name (Legal Business Name): GASTROENTEROLOGY AND CARDIAC ARRHYTHMIA SERVICE PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2009
Last Update Date: 04/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 PASEO HERRADURA
TRUJILLO ALTO PR
00976-6068
US

IV. Provider business mailing address

93 PASEO HERRADURA
TRUJILLO ALTO PR
00976-6068
US

V. Phone/Fax

Practice location:
  • Phone: 787-390-9090
  • Fax:
Mailing address:
  • Phone: 787-390-9090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number13,964
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number15,987
License Number StatePR

VIII. Authorized Official

Name: DR. LUARDE ISAAC MONTANO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-390-9090