Basic Information
| Provider Information | |||||||||
| NPI: | 1336120153 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHERN ANESTHESIA ASSOCIATES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 336030 | ||||||||
| Address2: | |||||||||
| City: | PONCE | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007336030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7872900135 | ||||||||
| FaxNumber: | 7872848045 | ||||||||
| Practice Location | |||||||||
| Address1: | 2225 PONCE BY PASS | ||||||||
| Address2: | EDIFICIO PARRA SUITE 404 | ||||||||
| City: | PONCE | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007317779 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7872845398 | ||||||||
| FaxNumber: | 7872848045 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2005 | ||||||||
| LastUpdateDate: | 09/17/2015 | ||||||||
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| AuthorizedOfficialLastName: | CUMMINGS | ||||||||
| AuthorizedOfficialFirstName: | MANUEL | ||||||||
| AuthorizedOfficialMiddleName: | SANTIAGO | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 7872845398 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 9957 | PR | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.