| Gastrovem, LLC | |
|
1607 Ave Ponce De Leon Ste Gm04 San Juan PR 00909-1803 | |
| (787) 910-0909 | |
| (888) 588-0319 |
| Full Name | Gastrovem, LLC |
|---|---|
| Speciality | Internal Medicine - Gastroenterology |
| Location | 1607 Ave Ponce De Leon Ste Gm04, San Juan, Puerto Rico |
| Authorized Official Name and Position | Vasco Eguia Moreda (PRESIDENT OWNER) |
| Authorized Official Contact | 7876335263 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gastrovem, LLC 1353 Ave Luis Vigoreaux Pmb 757 Guaynabo PR 00966-2715 Ph: (787) 910-0909 | Gastrovem, LLC 1607 Ave Ponce De Leon Ste Gm04 San Juan PR 00909-1803 Ph: (787) 910-0909 |
| NPI Number | 1467880146 |
|---|---|
| Provider Enumeration Date | 10/16/2013 |
| Last Update Date | 07/27/2021 |
| Certification Date | 06/29/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467880146 | NPI | - | NPPES |
| 037939901 | Medicaid | PR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | () | Primary |
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