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Organization
SOUTHEAST RENAL GROUP PSC
Active
Organization
SOUTHEAST RENAL GROUP PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LUIS A ORTIZ HEREDIA (PRESIDENT)
(787) 971-7133
Entity
Organization
Contact information
Practice address
SANTA ISABEL PROFESSIONAL BLDG, SUITE 205, SANTA ISABEL, PR 00757
(787) 971-7133
Mailing address
PO BOX 335432, PONCE, PR 00733-5432
(787) 971-7133
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
—
—
133N00000X
Nutritionist
—
—
207R00000X
Internal Medicine Physician
—
—
207RN0300X
Nephrology Physician
Primary
—
—
208D00000X
General Practice Physician
—
—
Other
Enumeration date
03/04/2014
Last updated
03/21/2017
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