Organization
SOUTH RENAL CARE, P.S.C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LUIS A ORTIZ HEREDIA MD (PRESIDENT)
(787) 362-0722
Entity
Organization
Contact information
Practice address
2275 PONCE BY PASS, CARIBBEAN MEDICAL CENTRE SUITE 202, PONCE, PR 00717-1380
(787) 840-1445
(787) 848-4657
Mailing address
PO BOX 335251, PONCE, PR 00733-5251
(787) 840-1455
(787) 848-4657
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
016621
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016621
PR MEDICAL LICENSE
PR
Enumeration date
06/13/2011
Last updated
06/13/2011
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