Healthcare Provider Details

I. General information

NPI: 1528942620
Provider Name (Legal Business Name): CASLCASIEU SURGICAL ANESTHESIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2025
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5150 ROBOTICS LN
LAKE CHARLES LA
70605-5284
US

IV. Provider business mailing address

5150 ROBOTICS LN
LAKE CHARLES LA
70605-5284
US

V. Phone/Fax

Practice location:
  • Phone: 337-214-2900
  • Fax:
Mailing address:
  • Phone: 337-214-2900
  • 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: JENNY BONO
Title or Position: ADMINISTRATOR
Credential: FACHE
Phone: 337-214-1591