Healthcare Provider Details

I. General information

NPI: 1740299080
Provider Name (Legal Business Name): NORTHERN CALIFORNIA ANESTHESIA ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 05/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 MOWRY AVE
FREMONT CA
94538-1716
US

IV. Provider business mailing address

PO BOX V
MOUNTAIN VIEW CA
94040-0150
US

V. Phone/Fax

Practice location:
  • Phone: 510-797-1111
  • Fax:
Mailing address:
  • Phone: 650-691-0611
  • Fax: 650-691-0614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ETHAN NICHOLLS
Title or Position: PRESIDENT
Credential:
Phone: 650-691-0611