Healthcare Provider Details

I. General information

NPI: 1255538658
Provider Name (Legal Business Name): CARMEL HEALTHCARE ANESTHESIA MEDICAL PROVIDERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 12/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23625 HOLMAN HIGHWAY
MONTEREY CA
93940
US

IV. Provider business mailing address

484 B WASHINGTON ST PMB 345
MONTEREY CA
93940
US

V. Phone/Fax

Practice location:
  • Phone: 831-624-5311
  • Fax:
Mailing address:
  • Phone: 209-956-7725
  • Fax: 209-956-7733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RICHARD J KELLY
Title or Position: GROUP PRESIDENT
Credential: MD
Phone: 831-624-5311