Provider Demographics
NPI:1265702724
Name:TACTICAL ANESTHESIA, PSC
Entity type:Organization
Organization Name:TACTICAL ANESTHESIA, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:RAMON
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-997-0870
Mailing Address - Street 1:PO BOX 250435
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00604-0435
Mailing Address - Country:US
Mailing Address - Phone:787-997-0870
Mailing Address - Fax:787-997-0870
Practice Address - Street 1:2 AVE SEVERIANO CUEVAS
Practice Address - Street 2:HOSP. BUEN SAMARITANO 3ER PISO OFICINA 330
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-5500
Practice Address - Country:US
Practice Address - Phone:787-997-0870
Practice Address - Fax:787-997-0870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-30
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10854207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty