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General NPI Number Information
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NPI Number | 1548090210
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Entity Type | Organization
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Legal Business Name | ABG ADVANCED GASTRO GROUP LLC
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Dates
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Enumeration Date | 08/06/2024
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Last Update Date | 08/06/2024
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Provider Practice Location Address
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Address Line | 1451 AVE ASHFORD
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City | SAN JUAN
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State | PR
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Zip | 00907-1511
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Country | US
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Telephone | 787-721-2160
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Fax |
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Provider Business Mailing Address
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Address Line | URB TIERRA ALTA II P6 CALLE LAS PALOMAS
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City | GUAYNABO
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State | PR
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Zip | 00969-3244
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Country | US
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Telephone |
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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. ALIANA M BOFILL GARCIA
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Credential | MD
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Telephone | 787-370-2513
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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 |
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License Number State |
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