MEDICARE: GPA SURGICAL PR LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)

General Provider Information

NPI Number	:	1619864790
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GPA SURGICAL PR LLC

Provider Business Mailing Address
First Line	:	1 CALLE INGA COND COSTAMAR
Second Line	:	6D
City	:	SAN JUAN
State	:	PR
Zip	:	00913
Country	:	US
Telephone Number	:	917-808-6093
Fax Number	:

Provider Business Practice Location Address
First Line	:	27 NELSON PEREA, DOCTOR'S CENTER
Second Line	:	SUITE 206
City	:	MAYAGUEZ
State	:	PR
Zip	:	00680-0037
Country	:	US
Telephone Number	:	917-808-6093
Fax Number	:

Authorized Official
Title or Position	:	ORAL & MAXILLOFACIAL SURGEON
Name	:	DR. GUILLERMO PUIG ARROYO
Credential	:	DMD
Telephone Number	:	917-808-6093

Provider Enumeration Date	:	06/20/2025
Last Update Date	:	06/09/2026

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