Basic Information
| Provider Information | |||||||||
| NPI: | 1639255409 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANESTHESIA & PAIN MANAGEMENT SERVICES OF PUEBLO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8971 | ||||||||
| Address2: | |||||||||
| City: | PUEBLO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 810088971 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195437877 | ||||||||
| FaxNumber: | 7195437882 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 W 16TH ST | ||||||||
| Address2: | |||||||||
| City: | PUEBLO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 810032745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195844420 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2006 | ||||||||
| LastUpdateDate: | 04/24/2019 | ||||||||
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| AuthorizedOfficialLastName: | QUINTANA-FRAZIER | ||||||||
| AuthorizedOfficialFirstName: | JUANITA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRACTICE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7195437877 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | CO | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.