Provider Demographics
NPI:1043374705
Name:ANESTESIOLOGOS DE SAN GERMAN, C.S.P.
Entity Type:Organization
Organization Name:ANESTESIOLOGOS DE SAN GERMAN, C.S.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BONILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-892-6972
Mailing Address - Street 1:PO BOX 66
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-0066
Mailing Address - Country:US
Mailing Address - Phone:787-892-1860
Mailing Address - Fax:787-892-6972
Practice Address - Street 1:2 CALLE CARRO
Practice Address - Street 2:HOSPITAL DE LA CONCEPCION 2ND FLOOR
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-4074
Practice Address - Country:US
Practice Address - Phone:787-892-1860
Practice Address - Fax:787-892-6972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherTAX ID
PR0088944Medicare ID - Type Unspecified