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General NPI Number Information
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NPI Number | 1144252198
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Entity Type | Organization
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Legal Business Name | INSTITUTO DE ENDOSCOPIA DIGESTIVA DEL SUR
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 450 C/FERROCARRIL, STE. 216 SANTA MARIA MEDICAL
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City | PONCE
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State | PR
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Zip | 00717-1105
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Country | US
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Telephone | 787-848-5897
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Fax | 787-284-4197
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Provider Business Mailing Address
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Address Line | 450 C/FERROCARRIL, STE. 216 SANTA MARIA MEDICAL
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City | PONCE
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State | PR
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Zip | 00717-1105
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Country | US
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Telephone | 787-848-5897
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Fax | 787-284-4197
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LUIS MARTINEZ-SIERRA
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Credential | MD
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Telephone | 787-848-5897
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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 | 6905
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 4589
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License Number State | PR
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