MEDICARE: WILSHIRE ANESTHESIA ASSOCIATES LLC

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	367500000X	Certified Registered Nurse Anesthetist

General Provider Information

NPI Number	:	1437696580
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILSHIRE ANESTHESIA ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	401 COMMERCE ST
Second Line	:	SUITE 600
City	:	NASHVILLE
State	:	TN
Zip	:	37219-2446
Country	:	US
Telephone Number	:	615-345-6900
Fax Number	:

Provider Business Practice Location Address
First Line	:	3200 WILSHIRE BLVD
Second Line	:	SUITE 101
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-1333
Country	:	US
Telephone Number	:	213-739-9988
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DALE W POLLEY
Credential	:
Telephone Number	:	615-345-6900

Provider Enumeration Date	:	01/27/2017
Last Update Date	:	01/27/2017

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