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General NPI Number Information
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NPI Number | 1245231497
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Entity Type | Organization
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Legal Business Name | GASTRO MED DEL SUR, P.S.C.
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Dates
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Enumeration Date | 08/09/2005
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Last Update Date | 12/29/2008
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Provider Practice Location Address
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Address Line | 909 AVE. TITO CASTRO SUITE 518 TORRE MEDICA SAN LUCAS
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City | PONCE
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State | PR
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Zip | 00716-4721
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Country | US
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Telephone | 787-290-2948
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Fax | 787-841-4832
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Provider Business Mailing Address
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Address Line | 909 AVE. TITO CASTRO SUITE 518 TORRE MEDICA SAN LUCAS
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City | PONCE
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State | PR
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Zip | 00716-4721
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Country | US
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Telephone | 787-290-2948
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Fax | 787-841-4832
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. CARMEN L. SANTIAGO
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Credential | M.D.
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Telephone | 787-290-2948
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 8042
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License Number State | PR
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