Provider Demographics
NPI:1770570343
Name:CARIBBEAN ANESTHESIA SERVICES OF FAJARDO
Entity type:Organization
Organization Name:CARIBBEAN ANESTHESIA SERVICES OF FAJARDO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MARRERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-314-5854
Mailing Address - Street 1:267 INGENIO
Mailing Address - Street 2:HACIENDA MARGARITA
Mailing Address - City:LUQUILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00773-3031
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:267 INGENIO
Practice Address - Street 2:HACIENDA MARGARITA
Practice Address - City:LUQUILLO
Practice Address - State:PR
Practice Address - Zip Code:00773-3031
Practice Address - Country:US
Practice Address - Phone:787-314-5854
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11002207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherFGP PROVIDER NUM
PRP958OtherIMC PROVIDER NUM