Healthcare Provider Details

I. General information

NPI: 1568914281
Provider Name (Legal Business Name): DBA ANESTHESIA ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2016
Last Update Date: 10/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 W LAKE MEAD PKWY # B18
HENDERSON NV
89015-6954
US

IV. Provider business mailing address

129 W LAKE MEAD PKWY # B18
HENDERSON NV
89015-6954
US

V. Phone/Fax

Practice location:
  • Phone: 702-564-4440
  • Fax: 702-558-1522
Mailing address:
  • Phone: 702-564-4440
  • Fax: 702-558-1522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberRN90611
License Number StateNV

VIII. Authorized Official

Name: FAATIMAH RASHEED
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 702-564-4440