MEDICARE: STATE OF THE ART ANESTHESIA 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	13848	PR

General Provider Information

NPI Number	:	1669843090
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STATE OF THE ART ANESTHESIA PSC

Provider Business Mailing Address
First Line	:	100 CALLE DEL MUELLE
Second Line	:	SUITE 501
City	:	SAN JUAN
State	:	PR
Zip	:	00901-2616
Country	:	US
Telephone Number	:	787-665-7215
Fax Number	:

Provider Business Practice Location Address
First Line	:	520 CALLE GOLFO DE NICOYA
Second Line	:	PASEO LOS CORALES 1
City	:	DORADO
State	:	PR
Zip	:	00646-4510
Country	:	US
Telephone Number	:	787-303-0198
Fax Number	:

Authorized Official
Title or Position	:	ANESTHESIOLOGY
Name	:	DR. IBSEN PEREZ SANTINI
Credential	:	M
Telephone Number	:	787-303-0198

Provider Enumeration Date	:	10/12/2015
Last Update Date	:	10/12/2015

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Directions to “STATE OF THE ART ANESTHESIA PSC ” Practice Location

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