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General NPI Number Information
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NPI Number | 1063842854
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Entity Type | Organization
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Legal Business Name | INSTITUTO DE GASTROENTEROLOGIA DE HUMACAO
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Dates
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Enumeration Date | 11/15/2013
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Last Update Date | 11/15/2013
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Provider Practice Location Address
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Address Line | 355 AVE FONT MARTELO SUITE 509
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City | HUMACAO
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State | PR
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Zip | 00791-3249
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Country | US
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Telephone | 787-656-0758
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Fax |
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Provider Business Mailing Address
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Address Line | COND PASEO DEL ROCIO APT 308
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City | SAN JUAN
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State | PR
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Zip | 00926-6672
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Country | US
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Telephone | 787-467-5812
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAGMARY PURCELL
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Credential |
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Telephone | 787-467-5812
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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 | 15902
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License Number State | PR
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