Healthcare Provider Details

I. General information

NPI: 1609327634
Provider Name (Legal Business Name): OASIS ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2016
Last Update Date: 10/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 COPA DE ORO DR
BREA CA
92823-7013
US

IV. Provider business mailing address

130 COPA DE ORO DR
BREA CA
92823-7013
US

V. Phone/Fax

Practice location:
  • Phone: 202-251-6521
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: RYLAN REYNOLDS
Title or Position: CRNA
Credential: CRNA, DNAP
Phone: 202-251-6521