Provider Demographics
NPI:1811082357
Name:SAN PABLO SURGICAL ASSOCIATES
Entity type:Organization
Organization Name:SAN PABLO SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EMILIO
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ-DE LEON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-269-6190
Mailing Address - Street 1:PASEO SAN PABLO #100
Mailing Address - Street 2:ED. ARTURO CADILLAS SUITE 201
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961
Mailing Address - Country:US
Mailing Address - Phone:787-269-6190
Mailing Address - Fax:787-269-6130
Practice Address - Street 1:PASEO SAN PABLO #100
Practice Address - Street 2:ED. ARTURO CADILLAS SUITE 201
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-269-6190
Practice Address - Fax:787-269-6130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRW99364Medicare UPIN
PR0087829Medicare PIN