Provider Demographics
NPI:1457131054
Name:WHITE GLOVE ANESTHESIA, LLC
Entity Type:Organization
Organization Name:WHITE GLOVE ANESTHESIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISMARY
Authorized Official - Middle Name:
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-309-8545
Mailing Address - Street 1:MENDEZ VIGO 410 SUITE 103
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-4510
Mailing Address - Country:US
Mailing Address - Phone:787-330-5424
Mailing Address - Fax:
Practice Address - Street 1:BAYAMON MEDICAL CENTER HOSPITAL
Practice Address - Street 2:ROAD #2 KM 11.7
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-320-8181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty