Healthcare Provider Details

I. General information

NPI: 1770527632
Provider Name (Legal Business Name): GRH ANESTHESIA GROUP, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COND TORRE AUXILIO MUTUO OFICINA 704 735 AVE PONCE DE LEON
SAN JUAN PR
00917-5026
US

IV. Provider business mailing address

COND TORRE AUXILIO MUTUO OFICINA 704 735 AVE PONCE DE LEON
SAN JUAN PR
00917-5026
US

V. Phone/Fax

Practice location:
  • Phone: 787-765-8620
  • Fax: 787-767-6138
Mailing address:
  • Phone: 787-765-8620
  • Fax: 787-767-6138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: AIXA MORENO
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 787-765-8620