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General NPI Number Information
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NPI Number | 1295711075
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Entity Type | Organization
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Legal Business Name | FRONT SIGHT ANESTHESIA, PSC
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Dates
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Enumeration Date | 12/22/2005
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Last Update Date | 04/22/2019
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Provider Practice Location Address
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Address Line | CARR #2 KM 129.3 BO VICTORIA OFICINA #13 AGUADILLA MEDICAL SERVICES
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City | AGUADILLA
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State | PR
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Zip | 00605
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Country | US
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Telephone | 787-997-0870
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Fax | 787-997-0870
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Provider Business Mailing Address
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Address Line | PO BOX 250435
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City | AGUADILLA
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State | PR
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Zip | 00604-0435
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Country | US
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Telephone | 787-907-0870
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Fax | 787-997-0870
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Authorized Official
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Title or Position | PRESIDENT / OWNER
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Name | JUAN RAMON JIMENEZ JR.
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Credential | MD
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Telephone | 787-640-1234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 10854
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License Number State | PR
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