# INSTITUTO DE GASTROENTEROLOGIA DE P.R.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Inst Gastroenterologia
- **Organization subpart:** No

## Provider details

- **NPI number:** 1942294012
- **Authorized official:** MR. PRUDENCIO A. LAUREANO M.H.S.A. (ADMINISTRATOR)
- **Authorized official phone:** (787) 764-8787

## Contact information

- **Practice address:** 400 AVE F.D. ROOSEVELT AVE., SUITE 206, SAN JUAN, PR 00918
- **Practice address phone:** (787) 764-8787
- **Practice address fax:** (787) 250-1029
- **Mailing address:** 400 AVE F.D, ROOSEVELT AVE., SUITE 206, SAN JUAN, PR 00918
- **Mailing address phone:** (787) 764-8787
- **Mailing address fax:** (787) 250-1029

## Taxonomy

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

## Other

- **Enumeration date:** 09/06/2005
- **Last updated:** 10/21/2011