Provider Demographics
NPI:1710011317
Name:MG ANESTHESIA AND PAIN MANAGEMENT SERVICES P.S.C.
Entity Type:Organization
Organization Name:MG ANESTHESIA AND PAIN MANAGEMENT SERVICES P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ELIZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-767-0102
Mailing Address - Street 1:CIMA DE TORRIMAR 14 CARR. 833
Mailing Address - Street 2:APT 1404
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-7405
Mailing Address - Country:US
Mailing Address - Phone:787-767-0102
Mailing Address - Fax:787-767-1899
Practice Address - Street 1:371 DE DIEGO ST.
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00923
Practice Address - Country:UM
Practice Address - Phone:787-767-0102
Practice Address - Fax:787-767-1899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5396174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherTAX ID NUMBER