Provider Demographics
NPI:1255517165
Name:DBA HUMACAO ANESTHESIA SERVICE
Entity type:Organization
Organization Name:DBA HUMACAO ANESTHESIA SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ANESTESIOLOGO
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:BAJANDAS DALY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-852-1945
Mailing Address - Street 1:PO BOX 489
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00792-0489
Mailing Address - Country:US
Mailing Address - Phone:787-852-1945
Mailing Address - Fax:787-850-2210
Practice Address - Street 1:URBANIZACION RIVERA DONATO CALLE JESUS M. RIVERA
Practice Address - Street 2:F9
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-852-1945
Practice Address - Fax:787-850-2210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0087910Medicare PIN
PRX13349Medicare UPIN