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General NPI Number Information
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NPI Number | 1093006520
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Entity Type | Organization
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Legal Business Name | DEC ANESTHESIA LLC
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Dates
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Enumeration Date | 05/02/2011
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Last Update Date | 08/29/2024
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Provider Practice Location Address
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Address Line | 603 W BASELINE RD STE 101
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City | MESA
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State | AZ
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Zip | 85210-6050
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Country | US
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Telephone | 480-969-0405
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Fax | 480-969-2280
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Provider Business Mailing Address
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Address Line | 603 W BASELINE RD STE 101
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City | MESA
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State | AZ
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Zip | 85210-6050
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Country | US
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Telephone | 480-690-4059
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Fax | 480-969-2280
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. SAMANTHA DILLON
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Credential |
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Telephone | 480-969-0405
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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