Healthcare Provider Details

I. General information

NPI: 1376840793
Provider Name (Legal Business Name): SAN DIEGO ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2011
Last Update Date: 02/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3434 MIDWAY DR STE 1008
SAN DIEGO CA
92110-4924
US

IV. Provider business mailing address

8721 SANTA MONICA BLVD # 222
WEST HOLLYWOOD CA
90069-4507
US

V. Phone/Fax

Practice location:
  • Phone: 310-273-8885
  • Fax:
Mailing address:
  • Phone: 310-273-8885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberA84519
License Number StateCA

VIII. Authorized Official

Name: MS. ARA SALAZAR
Title or Position: ADMINISTRATOR
Credential:
Phone: 310-273-8885