Basic Information
| Provider Information | |||||||||
| NPI: | 1952929994 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | METRO SANTURCE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 11137 | ||||||||
| Address2: | |||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876411616 | ||||||||
| FaxNumber: | 7872681182 | ||||||||
| Practice Location | |||||||||
| Address1: | 1462 CALLE PROFESOR AUGUSTO RODRIGUEZ | ||||||||
| Address2: | PARADA 22 | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876411616 | ||||||||
| FaxNumber: | 7872681162 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2020 | ||||||||
| LastUpdateDate: | 07/07/2020 | ||||||||
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| AuthorizedOfficialLastName: | AGUILA SASTRE | ||||||||
| AuthorizedOfficialFirstName: | MARCOS | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7876411616 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | METRO SANTURCE, INC | ||||||||
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| NPICertificationDate: | 07/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 208G00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 207L00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.