Healthcare Provider Details

I. General information

NPI: 1417342262
Provider Name (Legal Business Name): LIGHTWORK ANESTHESIOLOGY SERVICES PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 03/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ADMINISTRACION SERVICIOS MEDICOS DE PR CENTRO MEDICO DE PR BO MONACILLOS
SAN JUAN PR
00935
US

IV. Provider business mailing address

PO BOX 270074
SAN JUAN PR
00928-2874
US

V. Phone/Fax

Practice location:
  • Phone: 787-777-3535
  • Fax:
Mailing address:
  • Phone: 787-379-5456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number
License Number StatePR

VIII. Authorized Official

Name: DR. JOSE R. ORTIZ
Title or Position: PRESIDENT
Credential: MD
Phone: 787-379-5456