Healthcare Provider Details

I. General information

NPI: 1023213535
Provider Name (Legal Business Name): AZ ANESTHESIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6003 E BASELINE RD
MESA AZ
85206-4815
US

IV. Provider business mailing address

PO BOX 7096
STOCKTON CA
95267-0096
US

V. Phone/Fax

Practice location:
  • Phone: 480-641-6500
  • Fax:
Mailing address:
  • Phone: 209-956-7725
  • Fax: 209-956-7733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number14542
License Number StateAZ

VIII. Authorized Official

Name: PAUL ADDESSI
Title or Position: OWNER
Credential: MD
Phone: 480-641-6500