Basic Information
Provider Information
NPI: 1255517165
EntityType: 2
ReplacementNPI:  
OrganizationName: DBA HUMACAO ANESTHESIA SERVICE
LastName:  
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Mailing Information
Address1: PO BOX 489
Address2:  
City: HUMACAO
State: PR
PostalCode: 007920489
CountryCode: US
TelephoneNumber: 7878521945
FaxNumber: 7878502210
Practice Location
Address1: URBANIZACION RIVERA DONATO CALLE JESUS M. RIVERA
Address2: F9
City: HUMACAO
State: PR
PostalCode: 00791
CountryCode: US
TelephoneNumber: 7878521945
FaxNumber: 7878502210
Other Information
ProviderEnumerationDate: 01/10/2008
LastUpdateDate: 02/13/2008
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: BAJANDAS DALY
AuthorizedOfficialFirstName: AHMED
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AuthorizedOfficialTitleorPosition: ANESTESIOLOGO
AuthorizedOfficialTelephone: 7878521945
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: M.D.
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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