Basic Information
| Provider Information | |||||||||
| NPI: | 1629195920 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PAVIA ANESTHESIA PCS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 11211 | ||||||||
| Address2: | FERNANDEZ JUNCOS STATION | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009102311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878411949 | ||||||||
| FaxNumber: | 7878120565 | ||||||||
| Practice Location | |||||||||
| Address1: | SANTURCE & HATO REY | ||||||||
| Address2: | HOSPITAL PAVIA | ||||||||
| City: | SANTURCE | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878411949 | ||||||||
| FaxNumber: | 7878120565 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BARCELO | ||||||||
| AuthorizedOfficialFirstName: | JOSE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7877276555 | ||||||||
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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 | 8202 | PR | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.