Basic Information
| Provider Information | |||||||||
| NPI: | 1922171834 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HUMACAO ANESTHESIA SERVICE PSC | ||||||||
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| Mailing Information | |||||||||
| Address1: | BOX 489 | ||||||||
| Address2: | |||||||||
| City: | HUMACAO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00792 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878521945 | ||||||||
| FaxNumber: | 7878502210 | ||||||||
| Practice Location | |||||||||
| Address1: | URBANIZACION RIVERA DONATO | ||||||||
| Address2: | CALLE JESUS M RIVERA F9 | ||||||||
| City: | HUMACAO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00791 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878521945 | ||||||||
| FaxNumber: | 7878502210 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BAJANDAS DALY | ||||||||
| AuthorizedOfficialFirstName: | AHMED | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7878521945 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.