# GRUPO SAN MATEO, LLC

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

## Provider details

- **NPI number:** 1295293991
- **Authorized official:** DR. VASCO EGUIA MD (PRESIDENT OWNER)
- **Authorized official phone:** (787) 633-5263

## Contact information

- **Practice address:** 1607 AVE PONCE DE LEON STE GM04, SAN JUAN, PR 00909-1803
- **Practice address phone:** (787) 910-0909
- **Practice address fax:** (888) 588-0319
- **Mailing address:** 1353 AVE LUIS VIGOREAUX PMB 757, GUAYNABO, PR 00966-2715
- **Mailing address phone:** (787) 633-5263
- **Mailing address fax:** (888) 588-0319

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 133N00000X | Nutritionist | — | NULL | — |
| 133N00000X | Nutritionist | — | — | — |
| 133V00000X | Registered Dietitian | — | NULL | — |
| 133V00000X | Registered Dietitian | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 207RG0100X | Gastroenterology Physician | — | NULL | Yes |
| 207RG0100X | Gastroenterology Physician | — | — | Yes |
| 2080P0206X | Pediatric Gastroenterology Physician | — | NULL | — |
| 2080P0206X | Pediatric Gastroenterology Physician | — | — | — |
| 208D00000X | General Practice Physician | — | NULL | — |
| 208D00000X | General Practice Physician | — | — | — |
| 235Z00000X | Speech-Language Pathologist | — | NULL | — |
| 235Z00000X | Speech-Language Pathologist | — | — | — |
| 261QI0500X | Infusion Therapy Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 03/12/2019
- **Last updated:** 03/15/2023