Healthcare Provider Details

I. General information

NPI: 1639449291
Provider Name (Legal Business Name): PASADENA ANESTHESIA ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2012
Last Update Date: 01/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 66TH ST N
PINELLAS PARK FL
33781-5030
US

IV. Provider business mailing address

6094 14TH ST W STE 124
BRADENTON FL
34207-4104
US

V. Phone/Fax

Practice location:
  • Phone: 727-828-1460
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: GLENN S. FUOCO
Title or Position: MEMBER
Credential: DO
Phone: 727-828-1460