Healthcare Provider Details

I. General information

NPI: 1427229665
Provider Name (Legal Business Name): LM ANESTHESIA PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2008
Last Update Date: 01/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE PINERO #291
SAN JUAN PR
00918-4003
US

IV. Provider business mailing address

447 CALLE REINA DE LAS FLORES HACIENDA REAL
CAROLINA PR
00987-9786
US

V. Phone/Fax

Practice location:
  • Phone: 787-430-7246
  • Fax: 888-768-6686
Mailing address:
  • Phone: 787-430-7246
  • Fax: 888-768-6686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number14372
License Number StatePR

VIII. Authorized Official

Name: LINKA MATOS
Title or Position: DIRECTOR
Credential: MD
Phone: 787-430-7246