Healthcare Provider Details

I. General information

NPI: 1750154787
Provider Name (Legal Business Name): SOUTHERN BARIATRIC SERVICES PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2023
Last Update Date: 11/01/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 AVE TITO CASTO STE 723 TORRE MEDICA SAN LUCAS
PONCE PR
00716-4725
US

IV. Provider business mailing address

909 AVE TITO CASTO STE 723 TORRE MEDICA SAN LUCAS
PONCE PR
00716-4725
US

V. Phone/Fax

Practice location:
  • Phone: 787-290-4731
  • Fax:
Mailing address:
  • Phone: 787-290-4731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GUILLERMO BONLANOS
Title or Position: PRESIDENT
Credential: MD
Phone: 787-290-4731