1770527632 NPI number — GRH ANESTHESIA GROUP, PSC

Table of content: (NPI 1770527632)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770527632 NPI number — GRH ANESTHESIA GROUP, PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRH ANESTHESIA GROUP, PSC
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:
1770527632
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
COND TORRE AUXILIO MUTUO OFICINA 704
Provider Second Line Business Mailing Address:
735 AVE PONCE DE LEON
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00917-5026
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-765-8620
Provider Business Mailing Address Fax Number:
787-767-6138

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
COND TORRE AUXILIO MUTUO OFICINA 704
Provider Second Line Business Practice Location Address:
735 AVE PONCE DE LEON
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00917-5026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-765-8620
Provider Business Practice Location Address Fax Number:
787-767-6138
Provider Enumeration Date:
06/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MORENO
Authorized Official First Name:
AIXA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE ADMINISTRATOR
Authorized Official Telephone Number:
787-765-8620

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207LP2900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 84945 . This is a "SSS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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