MEDICARE: PRESBYTERIAN MEDICAL ANESTHESIA GROUP

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	4154	PR

General Provider Information

NPI Number	:	1851376040
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESBYTERIAN MEDICAL ANESTHESIA GROUP

Provider Business Mailing Address
First Line	:	1451 ASHFORD
Second Line	:	SUITE 2
City	:	SAN JUAN
State	:	PR
Zip	:	00907-1511
Country	:	US
Telephone Number	:	787-725-7860
Fax Number	:	787-722-3630

Provider Business Practice Location Address
First Line	:	PMB 423 1357 ASHFORD AVENUE
Second Line	:	SUITE 2
City	:	SAN JUAN
State	:	PR
Zip	:	00907-1420
Country	:	US
Telephone Number	:	787-725-7860
Fax Number	:	787-722-3630

Authorized Official
Title or Position	:	ADMINISTRATIVE PARTNER
Name	:	DR. BELISARIO MATTA DE JUAN SR.
Credential	:	M.D.
Telephone Number	:	787-725-7860

Provider Enumeration Date	:	12/09/2005
Last Update Date	:	08/22/2020

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Directions to “PRESBYTERIAN MEDICAL ANESTHESIA GROUP ” Practice Location

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