Provider Demographics
NPI:1053830059
Name:SOUTHEAST ANESTHESIA SERVICES, PSC
Entity Type:Organization
Organization Name:SOUTHEAST ANESTHESIA SERVICES, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:ROBLES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-318-0327
Mailing Address - Street 1:PO BOX 2998
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-2998
Mailing Address - Country:US
Mailing Address - Phone:787-318-0327
Mailing Address - Fax:
Practice Address - Street 1:AVENIDA PEDRO ALBIZU CAMPOS
Practice Address - Street 2:URBANIZACION LA HACIENDA
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784
Practice Address - Country:US
Practice Address - Phone:787-864-4300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-12
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10980207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR399041OtherPUERTO RICO DEPARTMENT OF STATE