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General NPI Number Information
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NPI Number | 1447799358
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Entity Type | Organization
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Legal Business Name | CENTRO GASTRO-ENDOSCOPICO DE LA MONTANA CORP
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Dates
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Enumeration Date | 02/13/2017
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Last Update Date | 02/13/2017
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Provider Practice Location Address
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Address Line | CARR 159 # KM27.4 COROZAL SHOPPING VILLAGE
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City | COROZAL
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State | PR
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Zip | 00783-2903
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Country | US
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Telephone | 787-802-1400
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Fax | 787-802-1200
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Provider Business Mailing Address
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Address Line | PO BOX 19006
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City | SAN JUAN
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State | PR
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Zip | 00910
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Country | US
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Telephone | 787-802-1400
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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. ELADIO PEREZ CRUZ
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Credential | M.D.
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Telephone | 787-802-1400
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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 | 8686
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License Number State | PR
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