Organization
COLON AND RECTAL SURGICAL GROUP OF PUERTO RICO PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SANTIAGO ANTONIO ULLOA (PRESIDENT)
(787) 707-0095
Entity
Organization
Contact information
Practice address
107 GONZALEZ GUISTI AVE, CAPARRA GALLERY BLDG SUITE 305, GUAYNABO, PR 00966-3017
(787) 707-0095
(787) 707-0096
Mailing address
PO BOX 19060, SAN JUAN, PR 00910-1060
(787) 707-0095
(787) 707-0096
Taxonomy
Speciality
Code
Description
License number
State
208C00000X
Colon & Rectal Surgery Physician
Primary
10722
PR
Other
Enumeration date
11/17/2006
Last updated
08/26/2010
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