Healthcare Provider Details

I. General information

NPI: 1669577342
Provider Name (Legal Business Name): SAN FRANCISCO PAIN MANAGEMENT GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 08/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

369 CALLE DE DIEGO SUITE #303 TORRE HOSPITAL SAN FRANCSICO
SAN JUAN PR
00923-3003
US

IV. Provider business mailing address

369 CALLE DE DIEGO SUITE #303 TORRE HOSPITAL SAN FRANCSICO
SAN JUAN PR
00923-3003
US

V. Phone/Fax

Practice location:
  • Phone: 787-763-9005
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number07B0740
License Number StatePR

VIII. Authorized Official

Name: MRS. CARMEN T. GUILBOT
Title or Position: OFICE MANAGER
Credential:
Phone: 787-763-9005