Healthcare Provider Details

I. General information

NPI: 1154931921
Provider Name (Legal Business Name): LA JOLLA ANESTHESIA SERVICES, APNC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2020
Last Update Date: 08/05/2020
Certification Date: 08/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 GENESEE AVE STE 880
LA JOLLA CA
92037-1233
US

IV. Provider business mailing address

2755 TOKALON ST
SAN DIEGO CA
92110-2236
US

V. Phone/Fax

Practice location:
  • Phone: 858-404-9929
  • Fax:
Mailing address:
  • Phone: 858-945-6138
  • Fax: 619-276-4216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: LEANN JOHNSON
Title or Position: PRESIDENT
Credential: CRNA
Phone: 858-945-6138