Provider Demographics
NPI:1285055624
Name:G C T SURGERY ,PSC
Entity type:Organization
Organization Name:G C T SURGERY ,PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INCORPORADOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:QUILICHINI
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:787-383-6162
Mailing Address - Street 1:1629 CALLE SANTA EDUVIGIS
Mailing Address - Street 2:URB.SAGRADO CORAZON
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-4228
Mailing Address - Country:US
Mailing Address - Phone:787-383-6162
Mailing Address - Fax:787-791-4834
Practice Address - Street 1:1629 CALLE SANTA EDUVIGIS
Practice Address - Street 2:URB.SAGRADO CORAZON
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-4228
Practice Address - Country:US
Practice Address - Phone:787-383-6162
Practice Address - Fax:787-791-4834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-03
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8778208600000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty