Healthcare Provider Details

I. General information

NPI: 1770691859
Provider Name (Legal Business Name): PREMIER ANESTHESIA OF CALIFORNIA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 NORRIS CANYON RD
SAN RAMON CA
94583-5400
US

IV. Provider business mailing address

2655 NORTHWINDS PKWY
ALPHARETTA GA
30009-2280
US

V. Phone/Fax

Practice location:
  • Phone: 925-275-9200
  • Fax:
Mailing address:
  • Phone: 770-643-5501
  • Fax: 404-941-1304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: RANDY WALKER
Title or Position: VP FIANCE
Credential:
Phone: 678-690-7812