Provider Demographics
NPI:1316942956
Name:HATO REY MEDICAL GASTRO,CSP
Entity type:Organization
Organization Name:HATO REY MEDICAL GASTRO,CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:C
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-274-1282
Mailing Address - Street 1:735 AVE PONCE DE LEON STE 809
Mailing Address - Street 2:TORRE MEDICA AUXILIO MUTUO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-5031
Mailing Address - Country:US
Mailing Address - Phone:787-274-1282
Mailing Address - Fax:787-764-0898
Practice Address - Street 1:735 AVE PONCE DE LEON STE 809
Practice Address - Street 2:TORRE MEDICA AUXILIO MUTUO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-5031
Practice Address - Country:US
Practice Address - Phone:787-274-1282
Practice Address - Fax:787-764-0898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-20
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12594207RG0100X
PR15480207RG0100X
PR7165207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0081464Medicare PIN