Provider Demographics
NPI:1477761526
Name:SOUTH CENTRAL ANESTHESIA CSP
Entity Type:Organization
Organization Name:SOUTH CENTRAL ANESTHESIA CSP
Other - Org Name:SCAACSP
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:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:787-380-6992
Mailing Address - Street 1:405 CALLE JB RODRIGUEZ
Mailing Address - Street 2:MIRADOR DEL PARQUE 1703-1
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-2673
Mailing Address - Country:US
Mailing Address - Phone:787-380-6992
Mailing Address - Fax:877-992-8231
Practice Address - Street 1:405 CALLE JB RODRIGUEZ
Practice Address - Street 2:MIRADOR DEL PARQUE 1703-1
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-2673
Practice Address - Country:US
Practice Address - Phone:787-380-6992
Practice Address - Fax:877-992-8231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5608207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty