Healthcare Provider Details

I. General information

NPI: 1336462621
Provider Name (Legal Business Name): ERIK CANCEL MOUNIER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2010
Last Update Date: 05/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE PONCE DE LEON # 728 201
SAN JUAN PR
00918-1000
US

IV. Provider business mailing address

PO BOX 3573
CAROLINA PR
00984-3573
US

V. Phone/Fax

Practice location:
  • Phone: 787-998-4957
  • Fax: 787-998-4958
Mailing address:
  • Phone: 787-998-4957
  • Fax: 787-998-4958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1533
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: