Healthcare Provider Details

I. General information

NPI: 1124064647
Provider Name (Legal Business Name): VALLEY ANESTHESIA, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 06/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 6TH ST
LEWISTON ID
83501-2431
US

IV. Provider business mailing address

3633 PACIFIC AVE SUITE 204
TACOMA WA
98418-7900
US

V. Phone/Fax

Practice location:
  • Phone: 208-743-2511
  • Fax:
Mailing address:
  • Phone: 253-274-1668
  • Fax: 253-274-1685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. FRANK DITTO III
Title or Position: PRESIDENT
Credential: M.D.
Phone: 208-743-2511