Healthcare Provider Details

I. General information

NPI: 1710400072
Provider Name (Legal Business Name): CCEC ANESTHESIA MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6421 SARATOGA BLVD BLDG 105
CORPUS CHRISTI TX
78414-3480
US

IV. Provider business mailing address

6421 SARATOGA BLVD BLDG 105
CORPUS CHRISTI TX
78414-3480
US

V. Phone/Fax

Practice location:
  • Phone: 361-985-9300
  • Fax:
Mailing address:
  • Phone: 361-985-9300
  • 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: ALAN RODRIGUEZ
Title or Position: CEO
Credential:
Phone: 908-653-9399