MEDICARE: GASTRO-HEPATOLOGY INSTITUTE OF PUERTO RICO 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	207RG0100X	Gastroenterology Physician
2	207RT0003X	Transplant Hepatology Physician

General Provider Information

NPI Number	:	1871270918
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GASTRO-HEPATOLOGY INSTITUTE OF PUERTO RICO LLC

Provider Business Mailing Address
First Line	:	1507 PASEOMONTE
Second Line	:	381 AVE FELISA RICON DE GAUTIER
City	:	SAN JUAN
State	:	PR
Zip	:	00926-6665
Country	:	US
Telephone Number	:	787-409-9940
Fax Number	:

Provider Business Practice Location Address
First Line	:	909 AVE TITO CASTRO SUITE 719 TORRE MEDICA SAN LUCAS
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00716-4722
Country	:	US
Telephone Number	:	787-401-9940
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENTE
Name	:	HENDRICK PAGAN-TORRES
Credential	:
Telephone Number	:	787-646-5592

Provider Enumeration Date	:	06/30/2023
Last Update Date	:	02/20/2026

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