# SOUTHWEST OTO AND HEAD & NECK SURGERY,PSC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1891104188
- **Authorized official:** DR. EDGAR DOMENECH FAGUNDO MD (OWNER)
- **Authorized official phone:** (787) 290-3333

## Contact information

- **Practice address:** TORRE MED SAN LUCAS, AVE. TITO CASTRO, PONCE, PR 00716-4728
- **Practice address phone:** (787) 290-3333
- **Practice address fax:** (787) 290-4444
- **Mailing address:** PO BOX 2000, PMB 137, MERCEDITA, PR 00715
- **Mailing address phone:** (787) 290-3333
- **Mailing address fax:** (787) 290-4444

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207YX0007X | Plastic Surgery within the Head & Neck (Otolaryngology) Physician | 13247 | PR | Yes |

## Other

- **Enumeration date:** 08/12/2014
- **Last updated:** 08/12/2014