Southwest Oto and Head & Neck Surgery,PSC

Primary specialty

Plastic Surgery within the Head & Neck (Otolaryngology) PhysicianTaxonomy code 207YX0007X

License

13247 Issued in PR

Legal business name

SOUTHWEST OTO AND HEAD & NECK SURGERY,PSC

Practice address

Torre Med San Lucas
Ave. Tito Castro
Ponce, PR 00716-4728

Phone

(787) 290-3333

Fax

(787) 290-4444

NPI assigned

Aug 12, 2014

Last updated

Aug 12, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Edgar Domenech Fagundo, MDNPI 1386717247

Title

Owner

Phone

(787) 290-3333

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PR

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Edgar E Domenech Fagundo, MD

  • Plastic Surgery within the Head & Neck (Otolaryngology) Physician
  • Ponce, PR
  • NPI 1386717247
  Medicare reassignment NPD Authorized official
• Lizbeth Rodriguez, M.S.A.

  • Audiologist
  • Ponce, PR
  • NPI 1508906884
  NPD (past)

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

{
    "created_epoch": "1407801600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407801600000",
    "number": "1891104188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2000",
            "address_2": "PMB 137",
            "city": "MERCEDITA",
            "state": "PR",
            "postal_code": "00715",
            "telephone_number": "787-290-3333",
            "fax_number": "787-290-4444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "TORRE MED SAN LUCAS",
            "address_2": "AVE. TITO CASTRO",
            "city": "PONCE",
            "state": "PR",
            "postal_code": "007164728",
            "telephone_number": "787-290-3333",
            "fax_number": "787-290-4444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST OTO AND HEAD & NECK SURGERY,PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-12",
        "last_updated": "2014-08-12",
        "status": "A",
        "authorized_official_last_name": "DOMENECH FAGUNDO",
        "authorized_official_first_name": "EDGAR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "787-290-3333",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207YX0007X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Plastic Surgery within the Head & Neck",
            "state": "PR",
            "license": "13247",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Southern Regional Blood Bank (Puerto Rico Blood Bank)
• Southern Retina Consultants PSC
• Southern Surgical Group LLC
• Southern Surgicenter
• Southwestern Cardiology Group, Inc
• Special Tactics and Rescue Services Corp
• Spine Puerto Rico LLC
• St Lukes Episcopal Church Home Care Program (Saint Lukes Home Care)
• St Lukes Episcopal Church Home Care Program (Saint Lukes Home Health Agency)

• Plastic Surgery within the Head & Neck (Otolaryngology) Physician in Ponce, PR
• Providers in Ponce, PR by specialty
• Plastic Surgery within the Head & Neck (Otolaryngology) Physician in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2014; 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.