Provider Demographics
NPI:1386368702
Name:FRC GASTRO LLC
Entity type:Organization
Organization Name:FRC GASTRO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:FABIOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIOS DE CHOUDENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-238-8628
Mailing Address - Street 1:RIVIERA VILLAGE 80 CALLE QUEENS
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:EDIFICIO DR. ARTURO CADILLA VINAS SUITE 210
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-238-1575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
No261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1124412010OtherPROVIDER NPI
NX689OtherMEDICARE PTAN