MEDICARE: STATE OF THE ART ANESTHESIA CORP

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	:	1760869812
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STATE OF THE ART ANESTHESIA CORP

Provider Business Mailing Address
First Line	:	100 CALLE DEL MUELLE
Second Line	:	SUTE 501
City	:	SAN JUAN
State	:	PR
Zip	:	00901-2616
Country	:	US
Telephone Number	:	787-289-2222
Fax Number	:	787-848-0318

Provider Business Practice Location Address
First Line	:	100 CALLE DEL MUELLE
Second Line	:	SUTE 501
City	:	SAN JUAN
State	:	PR
Zip	:	00901-2616
Country	:	US
Telephone Number	:	787-289-2222
Fax Number	:	787-848-0318

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. IBSSEN M PEREZ SANTINI
Credential	:	M.D.
Telephone Number	:	787-289-2222

Provider Enumeration Date	:	04/28/2015
Last Update Date	:	04/28/2015

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

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