Healthcare Provider Details

I. General information

NPI: 1407081003
Provider Name (Legal Business Name): PAIN MANAGEMENT AND ANESTHESIA SPECIALISTS OF PUERTO RICO, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2009
Last Update Date: 01/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE DE DIEGO #126 SEIN MEDICAL PLAZA SUITE 2
RIO PIEDRAS PR
00921
US

IV. Provider business mailing address

35 CALLE JUAN C BORBON STE 67-333
GUAYNABO PR
00969-5374
US

V. Phone/Fax

Practice location:
  • Phone: 787-675-0050
  • Fax:
Mailing address:
  • Phone: 787-239-9377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number17477
License Number StatePR

VIII. Authorized Official

Name: JAN J KRAEMER
Title or Position: PRESIDENT
Credential: MD
Phone: 617-669-0706