Provider Demographics
NPI:1629195920
Name:PAVIA ANESTHESIA PCS
Entity Type:Organization
Organization Name:PAVIA ANESTHESIA PCS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARCELO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-727-6555
Mailing Address - Street 1:PO BOX 11211
Mailing Address - Street 2:FERNANDEZ JUNCOS STATION
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-2311
Mailing Address - Country:US
Mailing Address - Phone:787-841-1949
Mailing Address - Fax:787-812-0565
Practice Address - Street 1:SANTURCE & HATO REY
Practice Address - Street 2:HOSPITAL PAVIA
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00920
Practice Address - Country:US
Practice Address - Phone:787-841-1949
Practice Address - Fax:787-812-0565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8202207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0088795Medicare ID - Type Unspecified