Provider Demographics
NPI:1942210158
Name:SOUTHERN PERIOPERATIVE MEDICINE ANESTHESIA
Entity Type:Organization
Organization Name:SOUTHERN PERIOPERATIVE MEDICINE ANESTHESIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:RIVAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-864-6389
Mailing Address - Street 1:ALBIZU CAMPOS AVE. URB. LA HACIENDA
Mailing Address - Street 2:CRISTO REDENTOR HOSP. ANESTHESIA OFFICE
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00784
Mailing Address - Country:US
Mailing Address - Phone:787-864-6389
Mailing Address - Fax:787-866-8413
Practice Address - Street 1:AVE. PEDRO ALBIZU CAMPOS
Practice Address - Street 2:URB. LA HACIENDA
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00785-4011
Practice Address - Country:US
Practice Address - Phone:787-864-6389
Practice Address - Fax:787-866-8413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0090369Medicare ID - Type Unspecified