Healthcare Provider Details

I. General information

NPI: 1336120153
Provider Name (Legal Business Name): SOUTHERN ANESTHESIA ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 09/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 PONCE BY PASS EDIFICIO PARRA SUITE 404
PONCE PR
00731-7779
US

IV. Provider business mailing address

PO BOX 336030
PONCE PR
00733-6030
US

V. Phone/Fax

Practice location:
  • Phone: 787-284-5398
  • Fax: 787-284-8045
Mailing address:
  • Phone: 787-290-0135
  • Fax: 787-284-8045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number9957
License Number StatePR

VIII. Authorized Official

Name: MR. MANUEL SANTIAGO CUMMINGS
Title or Position: MANAGING MEMBER
Credential: M.D.
Phone: 787-284-5398