Organization
SOUTHWEST OTO AND HEAD & NECK SURGERY,PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDGAR DOMENECH FAGUNDO MD (OWNER)
(787) 290-3333
Entity
Organization
Contact information
Practice address
TORRE MED SAN LUCAS, AVE. TITO CASTRO, PONCE, PR 00716-4728
(787) 290-3333
(787) 290-4444
Mailing address
PO BOX 2000, PMB 137, MERCEDITA, PR 00715
(787) 290-3333
(787) 290-4444
Taxonomy
Speciality
Code
Description
License number
State
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
Primary
13247
PR
Other
Enumeration date
08/12/2014
Last updated
08/12/2014
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