Provider Demographics
NPI:1417900549
Name:SOUTH CNTRAL ANESTHESIA CSP
Entity Type:Organization
Organization Name:SOUTH CNTRAL ANESTHESIA CSP
Other - Org Name:SOUTH CENTRAL ANESTHESIA & ASOOCIATES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:L
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:787-380-6992
Mailing Address - Street 1:PO BOX 428
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-0428
Mailing Address - Country:US
Mailing Address - Phone:787-864-7100
Mailing Address - Fax:787-864-4554
Practice Address - Street 1:VILLA ROSA I STREET
Practice Address - Street 2:#1
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784
Practice Address - Country:US
Practice Address - Phone:787-864-7100
Practice Address - Fax:787-864-4554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5608207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0027008Medicare ID - Type Unspecified