MEDICARE: AV ANESTHESIOLOGY GROUP PSC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	15740	PR

General Provider Information

NPI Number	:	1437488863
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AV ANESTHESIOLOGY GROUP PSC

Provider Business Mailing Address
First Line	:	URB CROWN HILLS 138
Second Line	:	AVE WINSTON CHURCHILL PMB 854
City	:	SAN JUAN
State	:	PR
Zip	:	00926-0613
Country	:	US
Telephone Number	:	787-758-8383
Fax Number	:	787-759-0101

Provider Business Practice Location Address
First Line	:	550 CALLE SERGIO CUEVAS
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00918-2683
Country	:	US
Telephone Number	:	787-407-1615
Fax Number	:	787-759-0101

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LYMARI VARGAS RIVERA
Credential	:	MD
Telephone Number	:	787-407-1615

Provider Enumeration Date	:	12/14/2009
Last Update Date	:	03/09/2017

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