SOUTHWEST OTO AND HEAD & NECK SURGERY,PSC (NPI# 1891104188) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891104188 |
| Entity Type | Organization |
| Organization Name | SOUTHWEST OTO AND HEAD & NECK SURGERY,PSC |
| Practice Address |
Torre Med San Lucas Ave. Tito Castro Ponce PR 00716-4728 |
| Mailing Address |
Po Box 2000 Pmb 137 Mercedita PR 00715 |
| Practice Telephone | 7872903333 |
| Practice Fax Number | 7872904444 |
| Mailing Telephone | 7872903333 |
| Mailing Fax Number | 7872904444 |
| Enumeration Date | 2014-08-12 |
| Last Update Date | 2014-08-12 |
| Authorized Official Name | DR. EDGAR DOMENECH FAGUNDO (OWNER) |
| Authorized Official Telephone | 7872903333 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207YX0007X |
Otolaryngology Specialization: Plastic Surgery within the Head & Neck |
13247 | PR | Allopathic & Osteopathic Physicians |
| Street Address |
TORRE MED SAN LUCAS AVE. TITO CASTRO |
| City | PONCE |
| State | PR |
| Zip Code | 00716-4728 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215031547 | Jorge I. Rodriguez Lugo | Internal Medicine | Torre Med San Lucas, 5to Piso Oficina 508, Ponce, PR 00716-4728 | 2006-09-08 |
| 1710362702 | Sanfina, Csp | Preferred Provider Organization | Torre Med San Lucas, 909 Tito Castro Ave Suite 609, Ponce, PR 00716-4728 | 2015-07-20 |
| 1689018723 | Breast Cancer Care, Csp | Internal Medicine | Torre Med San Lucas, , Suites 508-509, Ponce, PR 00716-4728 | 2013-04-19 |
| 1851632210 | First Choice Prosthetic | Durable Medical Equipment & Medical Supplies | Torre Med San Lucas, Ponce, PR 00716-4728 | 2013-03-11 |
| 1114285103 | Health South Primary Clinic | Clinic/Center | Torre Med San Lucas, Ponce, PR 00716-4728 | 2012-04-26 |
| 1992073233 | South Cancer Center | Clinic/Center | Torre Med San Lucas, 5to Piso Oficina 508, Ponce, PR 00716-4728 | 2011-12-01 |
| 1174759591 | Elsie N La Texera Csp | Clinic/Center | Torre Med San Lucas, Avenida Tito Castro Suite 125, Ponce, PR 00716-4728 | 2009-06-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275148041 | Amanda Ivette Orta Colon | General Practice | Los Caobos C/guayacan #1691, Ponce, PR 00716 | 2020-09-09 |
| 1568074052 | Isabel Victoria Vazquez Morales | Student in an Organized Health Care Education/Training Program | 388 Zona Industrial Rapada 2, Ponce, PR 00716 | 2020-08-18 |
| 1629687199 | Maria Elena Carvajal Mock | Student in an Organized Health Care Education/Training Program | La Alhambra, Calle Lindaraja 2609, Ponce, PR 00716 | 2020-07-30 |
| 1518576651 | Gabriel Domingo Palmieri Lagares | Student in an Organized Health Care Education/Training Program | Villa Del Carmen Ave Constancia 4406, Ponce, PR 00716 | 2020-07-24 |
| 1417565151 | Jose Rafael Pascual | Student in an Organized Health Care Education/Training Program | Phsu,388 Zona Industrial Reparada 2,ponce,pr 00716, Ponce, PR 00716 | 2020-07-20 |
| 1790302412 | Isha Marie Valerio Martinez | Social Worker | Urb Villa Del Carmen Ave Constancia, 4407, Ponce, PR 00716 | 2020-06-29 |
| 1619592011 | Luz Jeilin Morales Cruz | Psychologist | Urb Inductrial Reparada #291, Ponce, PR 00716 | 2020-06-11 |
| 1609491208 | Hogar Las Aguilas Incorporado | Custodial Care Facility | La Rambla Office Park, 621 Carr 14 Calle Marginal, Ponce, PR 00716 | 2020-06-10 |
| 1841813607 | Special Tactics and Rescue Services Corp | Case Management | 6020 Amalia Marin, Trucha, Ponce, PR 00716 | 2020-05-27 |
| 1629691274 | Heidi Ann Negron | Registered Nurse | Parcelas Sabanetas 25 Julio, 132, Ponce, PR 00716 | 2020-05-18 |
| Find all providers in zip 00716 | ||||
| Taxonomy Code | 207YX0007X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| Specialization | Plastic Surgery within the Head & Neck |
| An otolaryngologist with additional training in plastic and reconstructive procedures within the head, face, neck and associated structures, including cutaneous head and neck oncology and reconstruction, management of maxillofacial trauma, soft tissue repair and neural surgery. The field is diverse and involves a wide age range of patients, from the newborn to the aged. While both cosmetic and reconstructive surgeries are practiced, there are many additional procedures which interface with them. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Otolaryngology, 2007. http://www.aboto.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Otolaryngology. Board certification for Doctors of Osteopathy is currently provided in the subspecialty of Otolaryngology/Facial Plastic Surgery (see Taxonomy Code 207YX0905X) |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386717247 | Edgar E Domenech Fagundo | Otolaryngology | Torre Medica San Lucas, Ave. Tito Castro 917, Suite 618, Ponce, PR 00730 | 2006-11-16 |
| 1275591489 | Roberto Gonzalez Gonzalez | Otolaryngology | Salud Ave. #1326, Suite 511, Ponce, PR 00717-1689 | 2006-05-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568565547 | Recinto De Ciencias Medicas | Otolaryngology | Ave.americo Miranda Centro Medico De Pr Edif. Principal, Escuela De Medicina Aptdo.29134, San Juan, PR 00936-0134 | 2006-09-06 |
| 1902914807 | Benjamin Rodriguez Jr. | Otolaryngology | Manati Medical Plaza, Suite 205, Manati, PR 00674 | 2006-08-29 |
| 1508874876 | Jose I Almodovar - Laborde | Otolaryngology | Carr. 2 Km 174.0, San German Medical Plaza Suite 207, San German, PR 00683-9340 | 2006-08-03 |
| 1952300600 | Francisco R Suarez Lozada | Otolaryngology | 27 Calle Nelson Perea, Edificio Doctors Center Suite 102, Mayaguez, PR 00680-4949 | 2005-07-15 |
| 1740326677 | Grupo Otorrinolaringologico De Pr | Otolaryngology | Plaza Carolina Mall, Suite 11, Carolina, PR 00983 | 2007-01-29 |
| 1104987437 | Pablo M Lopez-baez | Otolaryngology | Santa Rosa Mall, 202a, Bayamon, PR 00959 | 2006-12-12 |
| 1952378341 | Jose R Sanchez-mendiola Sr. | Otolaryngology | Bayamon Medical Plaza, Suite 105, Bayamon, PR 00960 | 2006-03-03 |
| 1407820657 | Luis E Valledor Maeso Sr. | Otolaryngology | Bayamon Medical Plaza, Suite 105, Bayamon, PR 00960 | 2006-02-15 |
| 1003808171 | Jaime Luis Ortiz | Otolaryngology | Torre San Cristobal, 205 A, Coto Laurel, PR 00780 | 2005-08-16 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.