MEDICARE: MR. CHUCK ANDERSON HS

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	247200000X	Other Technician

General Provider Information

NPI Number	:	1689653339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHUCK ANDERSON HS

Provider Business Mailing Address
First Line	:	B20 CALLE 5
Second Line	:	SANTA ANNA AVE
City	:	GUAYNABO
State	:	PR
Zip	:	00969-6608
Country	:	US
Telephone Number	:	787-729-2305
Fax Number	:

Provider Business Practice Location Address
First Line	:	COMMANDING OFFICER 5 CALLE LA PUNTILLA
Second Line	:	USCG SECTOR SAN JUAN
City	:	SAN JUAN
State	:	PR
Zip	:	00901
Country	:	US
Telephone Number	:	787-729-2305
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	07/08/2007

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