Healthcare Provider Details

I. General information

NPI: 1396778924
Provider Name (Legal Business Name): TULARE ANESTHESIA ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 09/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

869 N CHERRY ST
TULARE CA
93274-2207
US

IV. Provider business mailing address

1187 N WILLOW AVE STE 103, PMB#300
CLOVIS CA
93611-4411
US

V. Phone/Fax

Practice location:
  • Phone: 559-688-0821
  • Fax:
Mailing address:
  • Phone: 559-324-7300
  • Fax: 559-324-7350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA37394
License Number StateCA

VIII. Authorized Official

Name: DR. ERNESTO JIMENEZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 559-905-3231