Provider Demographics
NPI:1386608446
Name:DE JESUS-TORRES, GASTROENTEROLOGOS DEL OESTE, CSP
Entity type:Organization
Organization Name:DE JESUS-TORRES, GASTROENTEROLOGOS DEL OESTE, CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARIA FACTURADORA
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAYNIL
Authorized Official - Middle Name:
Authorized Official - Last Name:VILANOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-264-4433
Mailing Address - Street 1:PO BOX 521
Mailing Address - Street 2:
Mailing Address - City:LAJAS
Mailing Address - State:PR
Mailing Address - Zip Code:00667
Mailing Address - Country:US
Mailing Address - Phone:787-264-4433
Mailing Address - Fax:787-892-0301
Practice Address - Street 1:CALLE DE DIEGO #16 OESTE
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-831-6060
Practice Address - Fax:787-892-0301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-14
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14742207RG0100X
PR14846207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
I15136Medicare UPIN
I05064Medicare UPIN
PR0084925Medicare ID - Type Unspecified