Healthcare Provider Details

I. General information

NPI: 1588165872
Provider Name (Legal Business Name): ASTERIA ANESTHESIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2018
Last Update Date: 02/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 E COTTON CENTER BLVD STE 155
PHOENIX AZ
85040-4803
US

IV. Provider business mailing address

26500 AGOURA RD STE 102-587
CALABASAS CA
91302-1952
US

V. Phone/Fax

Practice location:
  • Phone: 818-880-8605
  • Fax:
Mailing address:
  • Phone: 818-880-8605
  • Fax: 818-579-7916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: LYNN CRUZ
Title or Position: MANAGER
Credential:
Phone: 818-880-8605