Healthcare Provider Details

I. General information

NPI: 1023312741
Provider Name (Legal Business Name): RICHARD C ANESKO AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2011
Last Update Date: 07/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 N. CORONADO DRIVE SUITE B SIERRA VISTA RURAL HEALTH CARE CENTER
SIERRA VISTA AZ
85635
US

IV. Provider business mailing address

157 N CORONADO DR SUITE B
SIERRA VISTA AZ
85635-6360
US

V. Phone/Fax

Practice location:
  • Phone: 520-629-4802
  • Fax:
Mailing address:
  • Phone: 520-629-4802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberDA1790
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: