Provider Demographics
NPI:1386159549
Name:RCA GASTRO SERVICES P.S.C
Entity type:Organization
Organization Name:RCA GASTRO SERVICES P.S.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:CORDERO ARILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-717-4010
Mailing Address - Street 1:305 A SUITE TORRE SAN CRISTOBAL
Mailing Address - Street 2:AVE SAN CRISTOBAL
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780
Mailing Address - Country:US
Mailing Address - Phone:787-717-4010
Mailing Address - Fax:787-569-8301
Practice Address - Street 1:305A TORRE SAN CRISTOBAL
Practice Address - Street 2:
Practice Address - City:COTO LAUREL
Practice Address - State:PR
Practice Address - Zip Code:00780-2849
Practice Address - Country:US
Practice Address - Phone:787-717-4010
Practice Address - Fax:787-569-8301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-11
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========Medicaid