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General NPI Number Information
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NPI Number | 1700500063
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Entity Type | Organization
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Legal Business Name | EG PEDS GASTRO
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Dates
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Enumeration Date | 09/30/2022
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Last Update Date | 03/30/2023
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Provider Practice Location Address
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Address Line | BAYAMON MEDICAL PLAZA PR WOMEN'S AND CHILDREN'S HOSPITAL CARR 2 KM 11.7
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City | BAYAMON
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State | PR
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Zip | 00959
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Country | US
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Telephone | 787-466-8762
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 193307
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City | SAN JUAN
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State | PR
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Zip | 00919-3307
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Country | US
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Telephone | 787-466-8762
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ESTHERMARI GONZALEZ POLANCO
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Credential | MD
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Telephone | 787-407-7569
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0206X
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Taxonomy Name | Pediatric Gastroenterology Physician
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License Number |
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License Number State |
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