# INNOVATIVE GASTROENTEROLOGY, PSC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124315809
- **Authorized official:** DR. ROBERTO ENRIQUE MERA-LASTRA M.D. (PRESIDENT)
- **Authorized official phone:** (787) 657-8543

## Contact information

- **Practice address:** A1 AVE AGUSTIN PEREZ ANDINO, VILLAS DE RIO GRANDE, RIO GRANDE, PR 00745-3000
- **Practice address phone:** (787) 657-8543
- **Practice address fax:** (787) 657-8807
- **Mailing address:** PO BOX 3017, RIO GRANDE, PR 00745-3017
- **Mailing address phone:** (787) 657-8543
- **Mailing address fax:** (787) 657-8807

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RG0100X | Gastroenterology Physician | 15354 | PR | Yes |

## Other

- **Enumeration date:** 07/01/2011
- **Last updated:** 07/01/2011