Perio del Sur LLC

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

Legal business name

PERIO DEL SUR LLC

Practice address

909 Ave Tito Castro Ste 810
Ponce, PR 00716-4725

Phone

(787) 219-9032

NPI assigned

Aug 23, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Diego E Rodes, DDSNPI 1366176810

Title

President

Phone

(787) 219-9032

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in PR

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Diego Rodes

  • Periodontics
  • Ponce, PR
  • NPI 1366176810

  General Practice

  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1724371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724371200000",
    "number": "1689407785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3171",
            "city": "MAYAGUEZ",
            "state": "PR",
            "postal_code": "006813171",
            "telephone_number": "787-219-9032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 AVE TITO CASTRO STE 810",
            "city": "PONCE",
            "state": "PR",
            "postal_code": "007164725",
            "telephone_number": "787-219-9032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERIO DEL SUR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-23",
        "last_updated": "2024-08-23",
        "certification_date": "2024-08-23",
        "status": "A",
        "authorized_official_last_name": "RODES",
        "authorized_official_first_name": "DIEGO",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "787-219-9032",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nyliem Marie Perez
• Paola Perez
• Veronica Isabel Perez
• Yajaira Perez, PHD
• Zenaida Esther Perez, M.D.
• Pet Diagnostic Imaging Corp
• Matthew Virgil Peters, MD
• Nicole M. Peterson
• Physical Therapy-Ortho Rehab
• Jannette Piazza

• Periodontics in Ponce, PR
• Providers in Ponce, PR by specialty
• Periodontics in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.