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General NPI Number Information
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NPI Number | 1245846146
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Entity Type | Organization
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Legal Business Name | LOMA LINDA ANESTHESIA SERVICES A MEDICAL CORPORATION
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Dates
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Enumeration Date | 09/17/2020
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Last Update Date | 01/25/2021
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Provider Practice Location Address
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Address Line | 28062 BAXTER RD
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City | MURRIETA
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State | CA
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Zip | 92563-1401
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Country | US
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Telephone | 954-838-2370
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Fax |
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Provider Business Mailing Address
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Address Line | 7700 W SUNRISE BLVD
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City | PLANTATION
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State | FL
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Zip | 33322-4113
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICER
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Name | KATHY KONDAS
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Credential |
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Telephone | 954-939-7252
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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Taxonomy #3
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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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