Healthcare Provider Details

I. General information

NPI: 1417399429
Provider Name (Legal Business Name): LAKEVIEW ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2013
Last Update Date: 09/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 COLUMBIA DR STE A327
TAMPA FL
33606-3683
US

IV. Provider business mailing address

PO BOX 1590
LUTZ FL
33548-1590
US

V. Phone/Fax

Practice location:
  • Phone: 813-844-4396
  • Fax:
Mailing address:
  • Phone: 813-844-4396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CARLA GALANG
Title or Position: OWNER
Credential: MD
Phone: 908-653-9399