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General NPI Number Information
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NPI Number | 1134447162
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Entity Type | Organization
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Legal Business Name | MILKY WAY ANESTHESIA LLC
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Dates
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Enumeration Date | 05/14/2010
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Last Update Date | 03/02/2011
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Provider Practice Location Address
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Address Line | 10255 N 32ND ST
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City | PHOENIX
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State | AZ
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Zip | 85028-3851
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Country | US
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Telephone | 602-393-9103
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Fax | 602-254-3474
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Provider Business Mailing Address
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Address Line | 10255 N 32ND ST
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City | PHOENIX
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State | AZ
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Zip | 85028-3851
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Country | US
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Telephone | 602-393-9103
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. VELINA RUELAS
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Credential |
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Telephone | 602-393-9103
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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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