Provider Demographics
NPI:1649625013
Name:SOUTHERN INTERNAL MEDICINE INSTITUTE
Entity type:Organization
Organization Name:SOUTHERN INTERNAL MEDICINE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:RUBEN
Authorized Official - Last Name:MATOS FIGUEROA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-259-3316
Mailing Address - Street 1:609 AVE TITO CASTRO
Mailing Address - Street 2:STE 102 PMB 153
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716
Mailing Address - Country:US
Mailing Address - Phone:787-259-3316
Mailing Address - Fax:
Practice Address - Street 1:609 AVE TITO CASTRO
Practice Address - Street 2:STE 102 PMB 153
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-0200
Practice Address - Country:US
Practice Address - Phone:787-259-3316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11526261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR11526OtherINTERNAL MEDICINE
PR11526OtherINTERNAL MEDICINE