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General NPI Number Information
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NPI Number | 1114206315
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Entity Type | Organization
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Legal Business Name | SOUTHERN OBSTETRICS AND GYNECOLOGIC CENTER, P.S.C.
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Dates
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Enumeration Date | 08/05/2011
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Last Update Date | 09/07/2016
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Provider Practice Location Address
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Address Line | CALLE CARRION MADURO NUM 29
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City | JUANA DIAZ
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State | PR
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Zip | 00795-0000
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Country | US
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Telephone | 787-837-6419
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Fax | 787-260-4859
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Provider Business Mailing Address
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Address Line | F-89 CALLE REINA ISABEL MANSIONES PASEO DE REYES
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City | JUANA DIAZ
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State | PR
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Zip | 00795-4010
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Country | US
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Telephone | 787-837-6419
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Fax | 787-260-4859
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERTO BURGOS-RODRIGUEZ
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Credential | M.D.
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Telephone | 787-308-8547
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VX0000X
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Taxonomy Name | Obstetrics Physician
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License Number | 17318
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License Number State | PR
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