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General NPI Number Information
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NPI Number | 1063065811
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Entity Type | Organization
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Legal Business Name | ETC SOUTHERN ANESTHESIA SERVICES LLC
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Dates
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Enumeration Date | 07/22/2019
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Last Update Date | 07/22/2019
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Provider Practice Location Address
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Address Line | CARR 14 AVE TITO CASTRO SAN CRISTOBAL CANCER INSTITUTE
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City | PONCE
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State | PR
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Zip | 00716
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Country | US
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Telephone | 787-837-3575
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Fax | 787-837-3575
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Provider Business Mailing Address
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Address Line | PO BOX 800197
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City | COTO LAUREL
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State | PR
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Zip | 00780-0197
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Country | US
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Telephone | 787-486-7759
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Fax |
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Authorized Official
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Title or Position | PROPIETARY
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Name | MS. EMILETTE TORRES
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Credential |
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Telephone | 787-486-7759
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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