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Organization
INNOVATIVE GASTROENTEROLOGY, PSC
Active
Organization
INNOVATIVE GASTROENTEROLOGY, PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERTO ENRIQUE MERA-LASTRA M.D. (PRESIDENT)
(787) 657-8543
Entity
Organization
Contact information
Practice address
A1 AVE AGUSTIN PEREZ ANDINO, VILLAS DE RIO GRANDE, RIO GRANDE, PR 00745-3000
(787) 657-8543
(787) 657-8807
Mailing address
PO BOX 3017, RIO GRANDE, PR 00745-3017
(787) 657-8543
(787) 657-8807
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
15354
PR
Other
Enumeration date
07/01/2011
Last updated
07/01/2011
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