Provider Demographics
NPI:1356772651
Name:ANESTESIA EN CCALMA, C.S.P.
Entity type:Organization
Organization Name:ANESTESIA EN CCALMA, C.S.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:GONZALEZ CAMACHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-778-6195
Mailing Address - Street 1:1875 CARR.2
Mailing Address - Street 2:SUITE 301 MEDICAL OPHTHALMIC PLAZA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959
Mailing Address - Country:US
Mailing Address - Phone:787-778-6195
Mailing Address - Fax:787-251-1333
Practice Address - Street 1:1875 CARR 2
Practice Address - Street 2:SUITE 301
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-7208
Practice Address - Country:US
Practice Address - Phone:787-778-6195
Practice Address - Fax:787-251-1333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7224174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty