Healthcare Provider Details

I. General information

NPI: 1407769961
Provider Name (Legal Business Name): GRUPO QUIRURGICO SURESTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HOSPITAL MENONITA GUAYAMA SUITE 304
GUAYAMA PR
00785
US

IV. Provider business mailing address

PRINCIPE CARLOS T13 QUINTAS REALES
GUAYNABO PR
00969
US

V. Phone/Fax

Practice location:
  • Phone: 787-686-0135
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSE EMANUEL GARCIA RIVERA
Title or Position: SOLE MEMBER
Credential: MD
Phone: 787-390-9114