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General NPI Number Information
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NPI Number | 1336618594
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Entity Type | Organization
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Legal Business Name | DEEP DREAM ANESTHESIA LLC
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Dates
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Enumeration Date | 11/16/2018
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Last Update Date | 11/16/2018
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Provider Practice Location Address
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Address Line | 3955 E NAVIGATOR LN
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City | PHOENIX
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State | AZ
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Zip | 85050-5449
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Country | US
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Telephone | 713-598-3454
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Fax |
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Provider Business Mailing Address
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Address Line | 3955 E NAVIGATOR LN
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City | PHOENIX
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State | AZ
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Zip | 85050-5449
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Country | US
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Telephone | 713-598-3454
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SANDEEP MAYUR
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Credential |
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Telephone | 713-598-3454
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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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