Healthcare Provider Details
I. General information
NPI: 1417428970
Provider Name (Legal Business Name): SDA SERVICES OF CA
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 12/10/2018
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
800 E WASHINGTON BLVD
CRESCENT CITY CA
95531-8359
US
IV. Provider business mailing address
PO BOX 440448
NASHVILLE TN
37244-0448
US
V. Phone/Fax
- Phone: 707-464-8511
- Fax:
- Phone: 615-823-8024
- Fax: 615-823-8074
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207L00000X |
| Taxonomy | Anesthesiology Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
AARON
A
JONES
Title or Position: CEO
Credential: CRNA
Phone: 615-823-8024