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General NPI Number Information
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NPI Number | 1285693705
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Entity Type | Organization
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Legal Business Name | BRANDON ANESTHESIA ASSOCIATES LLC
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Dates
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Enumeration Date | 03/22/2006
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Last Update Date | 01/25/2010
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Provider Practice Location Address
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Address Line | 119 OAKFIELD DR
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City | BRANDON
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State | FL
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Zip | 33511-5779
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Country | US
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Telephone | 813-984-6263
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 861342
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City | ORLANDO
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State | FL
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Zip | 32886-1342
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Country | US
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Telephone | 813-984-6263
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JORGE L. ACOSTA
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Credential | M.D.
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Telephone | 813-984-6263
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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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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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