1710011317 NPI number — MG ANESTHESIA AND PAIN MANAGEMENT SERVICES P.S.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710011317 NPI number — MG ANESTHESIA AND PAIN MANAGEMENT SERVICES P.S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MG ANESTHESIA AND PAIN MANAGEMENT SERVICES P.S.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710011317
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CIMA DE TORRIMAR 14 CARR. 833
Provider Second Line Business Mailing Address:
APT 1404
Provider Business Mailing Address City Name:
GUAYNABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00969-7405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-767-0102
Provider Business Mailing Address Fax Number:
787-767-1899

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
371 DE DIEGO ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PUERTO RICO
Provider Business Practice Location Address Postal Code:
00923
Provider Business Practice Location Address Country Code:
UM
Provider Business Practice Location Address Telephone Number:
787-767-0102
Provider Business Practice Location Address Fax Number:
787-767-1899
Provider Enumeration Date:
03/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ELIZA
Authorized Official First Name:
MIGUEL
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-767-0102

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  5396 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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