Provider Demographics
NPI:1679279764
Name:PUERTO RICO GASTROENTEROLOGY LLC
Entity type:Organization
Organization Name:PUERTO RICO GASTROENTEROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRAY
Authorized Official - Middle Name:
Authorized Official - Last Name:ARROYO-MERCADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-621-2633
Mailing Address - Street 1:MMC PROFESSIONAL PLAZA
Mailing Address - Street 2:200 CALLE HERNANDEZ CARRION, SUITE 512
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674
Mailing Address - Country:US
Mailing Address - Phone:787-621-2633
Mailing Address - Fax:
Practice Address - Street 1:200 CALLE HERNANDEZ CARRION, SUITE 512
Practice Address - Street 2:MMC PROFESSIONAL PLAZA
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-0067
Practice Address - Country:US
Practice Address - Phone:787-621-2633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-01
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty