=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356772651
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANESTESIA EN CCALMA, C.S.P.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2013
-----------------------------------------------------
Last Update Date | 12/12/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1875 CARR 2 SUITE 301
-----------------------------------------------------
City | BAYAMON
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00959-7208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-778-6195
-----------------------------------------------------
Fax | 787-251-1333
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1875 CARR.2 SUITE 301 MEDICAL OPHTHALMIC PLAZA
-----------------------------------------------------
City | BAYAMON
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00959
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-778-6195
-----------------------------------------------------
Fax | 787-251-1333
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. LUIS A. GONZALEZ CAMACHO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-778-6195
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 7224
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------