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General NPI Number Information
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NPI Number | 1659091197
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Entity Type | Organization
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Legal Business Name | GAOD ENTERPRISES LLC
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Dates
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Enumeration Date | 09/02/2022
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Last Update Date | 12/15/2022
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Provider Practice Location Address
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Address Line | 33 F2 CALLE HIGUERO LADERAS DE SAN JUAN
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City | SAN JUAN
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State | PR
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Zip | 00926
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Country | US
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Telephone | 787-307-2727
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Fax |
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Provider Business Mailing Address
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Address Line | 33 CALLE HIGUERO LADERAS DE SAN JUAN
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City | SAN JUAN
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State | PR
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Zip | 00926
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Country | US
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Telephone | 787-307-2727
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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. GIOVANNI ALEXIS ORTIZ DIAZ
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Credential | MD
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Telephone | 787-236-2467
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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