Healthcare Provider Details

I. General information

NPI: 1740402940
Provider Name (Legal Business Name): ARIZONA ANESTHESIA CONSULTANTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 01/27/2020
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18205 N 51ST AVE STE. 109
GLENDALE AZ
85308-1490
US

IV. Provider business mailing address

9127 W RUSSELL RD STE 110
LAS VEGAS NV
89148-1253
US

V. Phone/Fax

Practice location:
  • Phone: 602-547-1400
  • Fax: 602-547-1401
Mailing address:
  • Phone: 702-878-0070
  • Fax: 702-209-2064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: LEORA J. BREWER
Title or Position: CREDENTIALING MANAGER WEST REGION
Credential:
Phone: 303-438-3999