Provider Demographics
NPI:1588976161
Name:SAN PATRICIO GASTROENTEROLOGY, PSC
Entity type:Organization
Organization Name:SAN PATRICIO GASTROENTEROLOGY, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FEDERICO
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-283-0804
Mailing Address - Street 1:101 SAN PATRICIO AVE.
Mailing Address - Street 2:SUITE 1050 MARAMAR PLAZA
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-2715
Mailing Address - Country:US
Mailing Address - Phone:787-946-5220
Mailing Address - Fax:787-946-5220
Practice Address - Street 1:101 SAN PATRICIO AVE.
Practice Address - Street 2:SUITE 1050 MARAMAR PLAZA
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966-2715
Practice Address - Country:US
Practice Address - Phone:787-946-5220
Practice Address - Fax:787-946-5220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-12
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14704207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty