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General NPI Number Information
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NPI Number | 1548397573
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Entity Type | Organization
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Legal Business Name | INSTITUTO DIGESTIVO DE PUERTO RICO, P.S.C.
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 04/16/2013
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Provider Practice Location Address
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Address Line | CONSOLIDATED MALL SUITE C-18
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City | CAGUAS
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State | PR
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Zip | 00725
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Country | US
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Telephone | 787-747-2530
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Fax | 787-744-6392
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Provider Business Mailing Address
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Address Line | PO BOX 7947
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City | CAGUAS
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State | PR
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Zip | 00726-7947
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Country | US
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Telephone | 787-747-2530
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Fax | 787-744-6392
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VICTOR J COLON-VAZQUEZ
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Credential | MD
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Telephone | 787-747-2530
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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 | 13117
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License Number State | PR
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