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General NPI Number Information
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NPI Number | 1215124680
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Entity Type | Organization
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Legal Business Name | MANATI GASTROINTESTINAL OFFICE PSC
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Dates
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Enumeration Date | 10/01/2007
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Last Update Date | 07/01/2015
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Provider Practice Location Address
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Address Line | CARR. # 2 KM. 47.7 HOSPITAL DOCTOR'S CENTER, TORRE ANTIGUA, OFICINA #404
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City | MANATI
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State | PR
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Zip | 00674-5507
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Country | US
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Telephone | 787-884-2426
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Fax | 787-854-8005
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Provider Business Mailing Address
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Address Line | PO BOX 411
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City | MANATI
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State | PR
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Zip | 00674-0411
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Country | US
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Telephone | 787-884-2426
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Fax | 787-854-8005
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WILSON ORTIZ COTTI
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Credential | MD
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Telephone | 787-884-2426
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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 | 7736
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License Number State | PR
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