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General NPI Number Information
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NPI Number | 1053293233
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Entity Type | Organization
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Legal Business Name | SOUTH KIDNEY CARE LLC
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Dates
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Enumeration Date | 07/21/2025
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Last Update Date | 07/21/2025
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Provider Practice Location Address
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Address Line | 1203 AVE MUNOZ RIVERA
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City | PONCE
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State | PR
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Zip | 00717-0634
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Country | US
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Telephone | 787-843-4588
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Fax |
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Provider Business Mailing Address
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Address Line | 7 CALLE PABELLONES
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City | PONCE
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State | PR
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Zip | 00730-3827
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Country | US
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Telephone | 787-843-4588
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Fax |
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Authorized Official
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Title or Position | PRESIDENTE
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Name | DR. NAHOMIE IVETTE VEGUILLA RIVERA
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Credential | MD
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Telephone | 787-843-4588
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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