Healthcare Provider Details

I. General information

NPI: 1629182977
Provider Name (Legal Business Name): SOUTHERN SURGICENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 01/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2213 PONCE BYP EDIF PARRA SUITE 201
PONCE PR
00717-1318
US

IV. Provider business mailing address

2213 PONCE BYP EDIF PARRA SUITE 201
PONCE PR
00717-1318
US

V. Phone/Fax

Practice location:
  • Phone: 787-841-0303
  • Fax:
Mailing address:
  • Phone: 787-841-0303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALEX CEDENO
Title or Position: ADMINISTRATOR
Credential:
Phone: 787-841-0303