| NPI | 1043038714 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAIME PONCE-PORTUGAL Owner 706-537-7499 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery |
| Additional Taxonomies | 207RB0002X Internal Medicine, Bariatric Medicine |
| Enumeration Date | 2024-10-01 |
| Last Update Date | 2024-10-17 |