1013977404 NPI number — MAK ANESTHESIA GROUP CSP

Table of content: (NPI 1013977404)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013977404 NPI number — MAK ANESTHESIA GROUP CSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAK ANESTHESIA GROUP CSP
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:
1013977404
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/11/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
EDIFICIO PARRA
Provider Second Line Business Mailing Address:
SUITE 805 2225 PONCE BIPASS
Provider Business Mailing Address City Name:
PONCE
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00716-1320
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-842-7931
Provider Business Mailing Address Fax Number:
787-842-7953

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
EDIFICIO PARRA
Provider Second Line Business Practice Location Address:
SUITE 805 2225 PONCE BIPASS
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00716-1320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-842-7931
Provider Business Practice Location Address Fax Number:
787-842-7953
Provider Enumeration Date:
03/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SANTIAGO
Authorized Official First Name:
ROSA
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-842-7931

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  11846 , 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)

  • Identifier: 89548 , issued by the state of ( PR ) . This identifiers is of the category "MEDICAID".




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