Provider Demographics
NPI:1053300541
Name:PROFESSIONAL ANESTHESIA PROVIDERS PSC
Entity Type:Organization
Organization Name:PROFESSIONAL ANESTHESIA PROVIDERS PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:
Authorized Official - Last Name:BECERRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-834-4347
Mailing Address - Street 1:PO BOX 939
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-0939
Mailing Address - Country:US
Mailing Address - Phone:787-834-4347
Mailing Address - Fax:787-265-7750
Practice Address - Street 1:CALLE DE DIEGO E # 55
Practice Address - Street 2:OFI 207 CPR BUILDING
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4866
Practice Address - Country:US
Practice Address - Phone:787-834-4347
Practice Address - Fax:787-265-7750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9473207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR70800051OtherHUMANA INS
PR84994OtherSSS
PR208028OtherPREFERRED HEALTH
PRAN2043OtherUIA
PR068944OtherLA CRUZ AZUL
PR08345OtherASOCIACION MAESTRO
PR03654OtherAMERICAN HEALTH
PRA103OtherINTERNATIONAL ME
PRPE4710OtherPALIC
PR=========OtherHUMANA MILITARI
PR=========OtherCIGNA HEALTH
PR=========OtherMCS CLASSIC CARE
PR068944OtherLA CRUZ AZUL
PR84994OtherSSS
PRA103OtherINTERNATIONAL ME
PR03654OtherAMERICAN HEALTH
PR70800051OtherHUMANA INS
PR03654OtherAMERICAN HEALTH