Southside Head N Neck Surgery Professional Corp

NPI #1194803338 in Colonial Heights, Virginia

Provider Information

NPI Number: 1194803338
Entity Type: Organization
Organization Name: Southside Head N Neck Surgery Professional Corp
Primary Specialty: Otolaryngology
Enumeration Date: Nov 2, 2006
Last Updated: Jul 1, 2014

Practice Location

Address: 930 SOUTH AVE.
Address 2: SUITE 4B
City: Colonial Heights
State: Virginia
ZIP Code: 23834
Phone: (804) 504-0530

Authorized Official

Name: DAVID CANGCUESTA, M.D.
Title: PHYSICIAN/OWNER
Phone: (804) 337-1110

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Otolaryngology	207Y00000X	Primary

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