| NPI | 1023664042 |
|---|---|
| Former Legal Business Name | SOUTH PRIME OB-GYN |
| Entity Type | Organization |
| Authorized Contact | LENNY G PAGAN President 787-633-9260 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207VX0000X Obstetrics & Gynecology, Obstetrics |
| Enumeration Date | 2019-08-15 |
| Last Update Date | 2019-08-15 |