Basic Information
| Provider Information | |||||||||
| NPI: | 1184294217 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GRUPO ANESTESIOLOGO DEL NORTE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2551 | ||||||||
| Address2: | |||||||||
| City: | ARECIBO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006132551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7873602717 | ||||||||
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| Practice Location | |||||||||
| Address1: | 55 CALLE PALMA | ||||||||
| Address2: | |||||||||
| City: | ARECIBO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006124526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876501030 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2021 | ||||||||
| LastUpdateDate: | 06/30/2021 | ||||||||
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| AuthorizedOfficialLastName: | MARRERO RUSSE | ||||||||
| AuthorizedOfficialFirstName: | JOSE | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7873602717 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 06/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.