Organization
CENTRO GASTRO-ENDOSCOPICO DE LA MONTANA CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELADIO PEREZ CRUZ M.D. (PRESIDENT)
(787) 802-1400
Entity
Organization
Contact information
Practice address
CARR 159 # KM27.4, COROZAL SHOPPING VILLAGE, COROZAL, PR 00783-2903
(787) 802-1400
(787) 802-1200
Mailing address
PO BOX 19006, SAN JUAN, PR 00910
(787) 802-1400
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
8686
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
390127
CERTIFICATE OF REGISTRY
PR
Enumeration date
02/13/2017
Last updated
02/13/2017
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