Healthcare Provider Details

I. General information

NPI: 1255517165
Provider Name (Legal Business Name): DBA HUMACAO ANESTHESIA SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2008
Last Update Date: 02/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URBANIZACION RIVERA DONATO CALLE JESUS M. RIVERA F9
HUMACAO PR
00791
US

IV. Provider business mailing address

PO BOX 489
HUMACAO PR
00792-0489
US

V. Phone/Fax

Practice location:
  • Phone: 787-852-1945
  • Fax: 787-850-2210
Mailing address:
  • Phone: 787-852-1945
  • Fax: 787-850-2210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. AHMED BAJANDAS DALY
Title or Position: ANESTESIOLOGO
Credential: M.D.
Phone: 787-852-1945