Healthcare Provider Details

I. General information

NPI: 1275221418
Provider Name (Legal Business Name): CANYON ANESTHESIA AND ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2023
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 N DURANGO DR STE 100
LAS VEGAS NV
89149-3939
US

IV. Provider business mailing address

6200 N DURANGO DR STE 100
LAS VEGAS NV
89149-3939
US

V. Phone/Fax

Practice location:
  • Phone: 702-660-5574
  • Fax:
Mailing address:
  • Phone: 702-660-5574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number
License Number State

VIII. Authorized Official

Name: DR. JESSE FALK
Title or Position: MANAGING MEMBER
Credential: DMD
Phone: 702-660-5574