Healthcare Provider Details

I. General information

NPI: 1891549002
Provider Name (Legal Business Name): CALIFORNIA PEDIATRIC ANESTHESIA CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2024
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7766 N PALM AVE STE 104
FRESNO CA
93711-5704
US

IV. Provider business mailing address

1187 N WILLOW AVE STE 103 #7
CLOVIS CA
93611-4411
US

V. Phone/Fax

Practice location:
  • Phone: 559-250-8344
  • Fax:
Mailing address:
  • Phone: 559-250-8344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: BRITTANY BOYER
Title or Position: CREDENTIALING
Credential:
Phone: 209-956-7732