Healthcare Provider Details

I. General information

NPI: 1346407434
Provider Name (Legal Business Name): BAY AREA ANESTHESIA ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2008
Last Update Date: 02/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4512 FEATHER RIVER DR SUITE C
STOCKTON CA
95219-6563
US

IV. Provider business mailing address

1157 SCOTLAND DR
CUPERTINO CA
95014-5061
US

V. Phone/Fax

Practice location:
  • Phone: 209-952-5538
  • Fax: 650-360-2807
Mailing address:
  • Phone: 415-506-7284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RAVI R PANKHANIYA
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MD
Phone: 415-506-7284