Provider Demographics
NPI:1073994729
Name:SERVICIOS QUIRURGICOS DEL SURESTE
Entity Type:Organization
Organization Name:SERVICIOS QUIRURGICOS DEL SURESTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:LUCAS
Authorized Official - Last Name:PIMENTEL FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-864-4860
Mailing Address - Street 1:62 CALLE BALDORIOTY
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00784
Mailing Address - Country:US
Mailing Address - Phone:787-864-4860
Mailing Address - Fax:787-864-7895
Practice Address - Street 1:CALLE BALDORIOTY #62
Practice Address - Street 2:
Practice Address - City:GUAYAMA
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00784
Practice Address - Country:UM
Practice Address - Phone:787-864-4860
Practice Address - Fax:787-864-7895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-17
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5007208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty