Healthcare Provider Details

I. General information

NPI: 1780770917
Provider Name (Legal Business Name): SOUTHERN HEALTH CARE GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 10/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SOUTHERN MEDICAL PLAZA CALLE 3 NUM 80 SUR
GUAYAMA PR
00784
US

IV. Provider business mailing address

PO BOX 1805
GUAYAMA PR
00785
US

V. Phone/Fax

Practice location:
  • Phone: 787-866-1212
  • Fax: 787-866-3322
Mailing address:
  • Phone: 787-866-1212
  • Fax: 787-866-3322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SERGIO R LOPEZ
Title or Position: DIRECTOR MEDICO
Credential: M.D.
Phone: 787-866-1212