Healthcare Provider Details

I. General information

NPI: 1033165097
Provider Name (Legal Business Name): VALLEY ANESTHESIA ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S 43RD ST
RENTON WA
98055-5714
US

IV. Provider business mailing address

PO BOX 84571
SEATTLE WA
98124-5871
US

V. Phone/Fax

Practice location:
  • Phone: 800-540-1814
  • Fax:
Mailing address:
  • Phone: 425-353-3788
  • Fax: 425-353-8041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RODRICK XUEREB
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 425-353-3788