Provider Demographics
NPI:1184871485
Name:GUAYNABO AMBULATORY SURGICAL GROUP, INC
Entity type:Organization
Organization Name:GUAYNABO AMBULATORY SURGICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MPHE
Authorized Official - Phone:787-522-2825
Mailing Address - Street 1:CITY VIEW PLAZA LOBBY SUITE 1010 TORRE II
Mailing Address - Street 2:CARR. 165 KM 1.2 #48
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968
Mailing Address - Country:US
Mailing Address - Phone:787-775-2020
Mailing Address - Fax:
Practice Address - Street 1:CARR 165 # KM1
Practice Address - Street 2:SUITE 1010 CITY VIEW PLAZA II
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968-8047
Practice Address - Country:US
Practice Address - Phone:787-775-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-19
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical