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General NPI Number Information
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NPI Number | 1649625013
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Entity Type | Organization
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Legal Business Name | SOUTHERN INTERNAL MEDICINE INSTITUTE
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Dates
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Enumeration Date | 05/04/2016
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Last Update Date | 05/04/2016
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Provider Practice Location Address
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Address Line | 609 AVE TITO CASTRO STE 102 PMB 153
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City | PONCE
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State | PR
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Zip | 00716-0200
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Country | US
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Telephone | 787-259-3316
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Fax |
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Provider Business Mailing Address
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Address Line | 609 AVE TITO CASTRO STE 102 PMB 153
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City | PONCE
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State | PR
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Zip | 00716
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Country | US
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Telephone | 787-259-3316
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Fax |
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Authorized Official
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Title or Position | PYSICIAN
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Name | DR. JORGE RUBEN MATOS FIGUEROA
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Credential |
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Telephone | 787-259-3316
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 11526
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License Number State | PR
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