Basic Information
| Provider Information | |||||||||
| NPI: | 1467966812 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARIBBEAN SUN ANESTHESIA LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 361 CALLE GALILEO APT 14F | ||||||||
| Address2: | |||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009274549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054943811 | ||||||||
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| Practice Location | |||||||||
| Address1: | KM 0. CALLE 129 | ||||||||
| Address2: | HOSPITAL PAVIA ARECIBO | ||||||||
| City: | ARECIBO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876507272 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2017 | ||||||||
| LastUpdateDate: | 11/21/2017 | ||||||||
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| AuthorizedOfficialLastName: | LASSALLE | ||||||||
| AuthorizedOfficialFirstName: | CARLOS | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 7878787272 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 17949 | PR | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.