Basic Information
| Provider Information | |||||||||
| NPI: | 1144998451 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GASTRO HEALTH, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1002 S OLD DIXIE HWY STE 201 | ||||||||
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| City: | JUPITER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334587202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617442200 | ||||||||
| FaxNumber: | 8883359884 | ||||||||
| Practice Location | |||||||||
| Address1: | 1002 S OLD DIXIE HWY STE 201 | ||||||||
| Address2: | |||||||||
| City: | JUPITER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334587202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617442200 | ||||||||
| FaxNumber: | 8883359884 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2021 | ||||||||
| LastUpdateDate: | 09/02/2021 | ||||||||
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| AuthorizedOfficialLastName: | GARCIA | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3054684185 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.