Provider Demographics
NPI:1154373546
Name:NEFROSUR CSP
Entity type:Organization
Organization Name:NEFROSUR CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:RIVERA SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-840-1455
Mailing Address - Street 1:609 AVE TITO CASTRO
Mailing Address - Street 2:PMB 173 STE 102
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-0200
Mailing Address - Country:US
Mailing Address - Phone:787-840-1455
Mailing Address - Fax:787-848-4657
Practice Address - Street 1:2275 PONCE BY PASS
Practice Address - Street 2:CARIBBEAN MEDICAL CENTER STE 202
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1380
Practice Address - Country:US
Practice Address - Phone:787-840-1455
Practice Address - Fax:787-848-4657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0088549Medicare ID - Type Unspecified
G21665Medicare UPIN