Healthcare Provider Details

I. General information

NPI: 1932254281
Provider Name (Legal Business Name): CYPRESS ANESTHESIA MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 04/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

842 S. AKERS STREET
VISALIA CA
93277-8309
US

IV. Provider business mailing address

PO BOX 7096
STOCKTON CA
95267-0096
US

V. Phone/Fax

Practice location:
  • Phone: 559-740-4094
  • Fax: 559-740-4100
Mailing address:
  • Phone: 209-956-7725
  • Fax: 209-956-7733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: GUILLERMO MANTUANO
Title or Position: MD
Credential:
Phone: 559-436-0871