Healthcare Provider Details

I. General information

NPI: 1124586490
Provider Name (Legal Business Name): VALLEY ANESTHESIA AND ANCILLARY SERVICES, INC.,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2019
Last Update Date: 03/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5435 BALBOA BLVD STE 101
ENCINO CA
91316-1686
US

IV. Provider business mailing address

5435 BALBOA BLVD STE 101
ENCINO CA
91316-1686
US

V. Phone/Fax

Practice location:
  • Phone: 818-990-2383
  • Fax: 818-322-3100
Mailing address:
  • Phone: 818-990-2383
  • Fax: 818-322-3100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: ELSA MAFFEI
Title or Position: BILLING MANAGER
Credential:
Phone: 818-501-2001