Healthcare Provider Details

I. General information

NPI: 1255494803
Provider Name (Legal Business Name): WEST COAST ANESTHESIOLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 11/14/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2621 CATTLEMEN RD STE 202
SARASOTA FL
34232-6212
US

IV. Provider business mailing address

2621 CATTLEMEN RD STE 202
SARASOTA FL
34232-6212
US

V. Phone/Fax

Practice location:
  • Phone: 941-365-5672
  • Fax: 941-365-5854
Mailing address:
  • Phone: 941-365-5672
  • Fax: 941-365-5854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberME37642
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberME116503
License Number StateFL

VIII. Authorized Official

Name: MRS. MARLO A REYES
Title or Position: PRACTICE MANAGER
Credential:
Phone: 941-365-5672