Provider Demographics
NPI:1417342262
Name:LIGHTWORK ANESTHESIOLOGY SERVICES PSC
Entity Type:Organization
Organization Name:LIGHTWORK ANESTHESIOLOGY SERVICES PSC
Other - Org Name:LIGHTWORK ANESTHESIOLOGY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:R
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-379-5456
Mailing Address - Street 1:PO BOX 270074
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00928-2874
Mailing Address - Country:US
Mailing Address - Phone:787-379-5456
Mailing Address - Fax:
Practice Address - Street 1:ADMINISTRACION SERVICIOS MEDICOS DE PR
Practice Address - Street 2:CENTRO MEDICO DE PR BO MONACILLOS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00935
Practice Address - Country:US
Practice Address - Phone:787-777-3535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-30
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR207L00000X, 367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist AssistantGroup - Single Specialty