Healthcare Provider Details

I. General information

NPI: 1912521881
Provider Name (Legal Business Name): INNERPEACE ANESTHESIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2020
Last Update Date: 06/05/2020
Certification Date: 06/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10884 SANTA MONICA BLVD
LAS ANGELES CA
90025-4646
US

IV. Provider business mailing address

5 HALLAND #101
IRVINE CA
92618-2568
US

V. Phone/Fax

Practice location:
  • Phone: 855-818-2020
  • Fax:
Mailing address:
  • Phone: 949-588-2190
  • Fax: 949-588-2199

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: MIGUEL LOPEZ
Title or Position: PRESIDENT
Credential: CRNA
Phone: 559-349-6653