Healthcare Provider Details

I. General information

NPI: 1154021160
Provider Name (Legal Business Name): PR ANESTHESIOLOGY AND PAIN MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2023
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 AVE. DE DIEGO SUITE 300 EDIF. SAN JUAN HEALTH CENTRE
SAN JUAN PR
00907
US

IV. Provider business mailing address

CALLE BAYONA 1105 PUERTO NUEVO
SAN JUAN PR
00920
US

V. Phone/Fax

Practice location:
  • Phone: 787-547-9834
  • Fax:
Mailing address:
  • Phone: 787-547-9834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. EMMANUEL LOPEZ-NOGUERAS
Title or Position: PRESIDENT
Credential: MD
Phone: 787-547-9834