Healthcare Provider Details

I. General information

NPI: 1184855678
Provider Name (Legal Business Name): ANODYNE ANESTHESIA ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2009
Last Update Date: 07/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9674 ARCHIBALD AVE SUITE 125
RANCHO CUCAMONGA CA
91730-7941
US

IV. Provider business mailing address

PO BOX 511457
LOS ANGELES CA
90051-8012
US

V. Phone/Fax

Practice location:
  • Phone: 615-620-2320
  • Fax: 615-620-2323
Mailing address:
  • Phone: 615-620-2320
  • Fax: 615-620-2323

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: KENNETH CRAWFORD
Title or Position: OWNER
Credential: CRNA
Phone: 615-620-2320