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General NPI Number Information
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NPI Number | 1033261862
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Entity Type | Organization
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Legal Business Name | SOUTHERN GASTROENTEROLOGY MEDICAL GROUP, PSC
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7810 CALLE NAZARET URB SANTA MARIA
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City | PONCE
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State | PR
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Zip | 00717-1008
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Country | US
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Telephone | 787-843-0348
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Fax | 787-840-8623
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Provider Business Mailing Address
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Address Line | PO BOX 7183
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City | PONCE
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State | PR
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Zip | 00732-7183
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Country | US
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Telephone | 787-843-0348
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Fax | 787-840-8623
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ARNALDO M NIEVES
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Credential | M.D.
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Telephone | 787-843-0348
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 12225
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License Number State | PR
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