Healthcare Provider Details

I. General information

NPI: 1932485596
Provider Name (Legal Business Name): S & P ANESTHESIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2011
Last Update Date: 11/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 HOOKS STREET
CLERMONT FL
34711
US

IV. Provider business mailing address

2440 HOOKS STREET
CLERMONT FL
34711
US

V. Phone/Fax

Practice location:
  • Phone: 352-394-0833
  • Fax: 352-394-0367
Mailing address:
  • Phone: 352-394-0833
  • Fax: 352-394-0367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberOS8836
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. SAMILDRE PACHECO
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 352-394-0833