Provider Demographics
NPI:1053516195
Name:P.J.M. SURGICAL, P.S.C.
Entity type:Organization
Organization Name:P.J.M. SURGICAL, P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PLASTIC SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:GUSTAVO
Authorized Official - Middle Name:ADOLFO
Authorized Official - Last Name:COLBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-805-3232
Mailing Address - Street 1:PO BOX 901
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-0901
Mailing Address - Country:US
Mailing Address - Phone:787-805-8140
Mailing Address - Fax:
Practice Address - Street 1:351 AVE HOSTOS
Practice Address - Street 2:EDIF MEDICAL EMPORIUM #209
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-1502
Practice Address - Country:US
Practice Address - Phone:787-805-3232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11240174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty