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General NPI Number Information
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NPI Number | 1427862481
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Entity Type | Organization
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Legal Business Name | SOUTHERN SURGICAL GROUP LLC
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Dates
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Enumeration Date | 02/01/2025
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Last Update Date | 08/01/2025
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Provider Practice Location Address
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Address Line | 1010 PASEO DEL VETERANO
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City | PONCE
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State | PR
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Zip | 00716-2001
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Country | US
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Telephone | 787-492-0111
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Fax | 787-812-1034
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Provider Business Mailing Address
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Address Line | 70 AVE PONCE DE LEON STE 160
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City | SAN JUAN
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State | PR
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Zip | 00918-1627
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Country | US
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Telephone | 787-492-0111
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | HECTOR MANUEL LOPEZ GONZALEZ
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Credential | MD, MHA
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Telephone | 787-492-0111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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