Provider Demographics
NPI:1669843090
Name:STATE OF THE ART ANESTHESIA PSC
Entity Type:Organization
Organization Name:STATE OF THE ART ANESTHESIA PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ANESTHESIOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:IBSEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ SANTINI
Authorized Official - Suffix:
Authorized Official - Credentials:M
Authorized Official - Phone:787-303-0198
Mailing Address - Street 1:100 CALLE DEL MUELLE
Mailing Address - Street 2:SUITE 501
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00901-2616
Mailing Address - Country:US
Mailing Address - Phone:787-665-7215
Mailing Address - Fax:
Practice Address - Street 1:520 CALLE GOLFO DE NICOYA
Practice Address - Street 2:PASEO LOS CORALES 1
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-4510
Practice Address - Country:US
Practice Address - Phone:787-303-0198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-12
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13848207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZI06297Medicare UPIN