Provider Demographics
NPI:1770527632
Name:GRH ANESTHESIA GROUP, PSC
Entity type:Organization
Organization Name:GRH ANESTHESIA GROUP, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AIXA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-765-8620
Mailing Address - Street 1:COND TORRE AUXILIO MUTUO OFICINA 704
Mailing Address - Street 2:735 AVE PONCE DE LEON
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-5026
Mailing Address - Country:US
Mailing Address - Phone:787-765-8620
Mailing Address - Fax:787-767-6138
Practice Address - Street 1:COND TORRE AUXILIO MUTUO OFICINA 704
Practice Address - Street 2:735 AVE PONCE DE LEON
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-5026
Practice Address - Country:US
Practice Address - Phone:787-765-8620
Practice Address - Fax:787-767-6138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Not Answered207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR84945OtherSSS
PR0084945Medicare ID - Type Unspecified