Healthcare Provider Details

I. General information

NPI: 1194504787
Provider Name (Legal Business Name): SONORAN DREAM ANESTHESIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 09/25/2023
Certification Date: 09/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5780 N SWAN RD STE 180
TUCSON AZ
85718-4527
US

IV. Provider business mailing address

5780 N SWAN RD STE 180
TUCSON AZ
85718-4527
US

V. Phone/Fax

Practice location:
  • Phone: 520-448-9490
  • Fax:
Mailing address:
  • Phone: 520-448-9490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RAMAN MAHABIR
Title or Position: CEO
Credential: MD
Phone: 602-499-4599