=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457201006
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PREMIER GASTROENTEROLOGY GROUP LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/02/2026
-----------------------------------------------------
Last Update Date | 02/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | AVE LUIS MUNOZ MARIN # 5
-----------------------------------------------------
City | OROCOVIS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00720-4417
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-867-0736
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | AVE LUIS MUNOZ MARIN # 5
-----------------------------------------------------
City | OROCOVIS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00720-4417
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-867-0736
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD PRESIDENTE
-----------------------------------------------------
Name | DR. CARLA M CEPERO JIMENEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-867-0736
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------