Provider Demographics
NPI:1215212519
Name:SERVICIOS PROFESIONALES AMBULATORIOS
Entity Type:Organization
Organization Name:SERVICIOS PROFESIONALES AMBULATORIOS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:L
Authorized Official - Last Name:BAYRON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-832-1585
Mailing Address - Street 1:ETHEL MARIN 1114
Mailing Address - Street 2:PASEO LOS ROBLES
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00682
Mailing Address - Country:UM
Mailing Address - Phone:787-832-1585
Mailing Address - Fax:787-832-1585
Practice Address - Street 1:ETHEL MARIN #1114
Practice Address - Street 2:PASEO LOS ROBLES
Practice Address - City:MAYAGUEZ
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00682
Practice Address - Country:UM
Practice Address - Phone:787-832-1585
Practice Address - Fax:787-832-1585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-18
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12790207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty