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General NPI Number Information
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NPI Number | 1003144569
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Entity Type | Organization
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Legal Business Name | RVW GASTROENTEROLOGY PSC
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Dates
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Enumeration Date | 11/21/2009
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Last Update Date | 08/28/2011
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Provider Practice Location Address
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Address Line | 11 CALLE CARAZO
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City | GUAYNABO
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State | PR
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Zip | 00969-5636
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Country | US
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Telephone | 787-220-4053
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2320
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City | GUAYNABO
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State | PR
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Zip | 00970-2320
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Country | US
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Telephone | 787-428-7313
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. ROBERTO M VENDRELL
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Credential | MD
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Telephone | 787-428-7313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 16266
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License Number State | PR
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