Healthcare Provider Details

I. General information

NPI: 1588831531
Provider Name (Legal Business Name): SURGICAL ANESTHESIA SERVICES OF CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2008
Last Update Date: 04/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 COWELL BLVD. SUITE 142
DAVIS CA
95618-7840
US

IV. Provider business mailing address

13523 BARRETT PARKWAY DRIVE SUITE 104
BALLWIN MO
63021-3802
US

V. Phone/Fax

Practice location:
  • Phone: 530-750-7755
  • Fax: 530-750-7767
Mailing address:
  • Phone: 636-549-2404
  • Fax: 636-549-2392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: ANDREW R RIBAUDO
Title or Position: PRESIDENT
Credential:
Phone: 404-217-2659