=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487986865
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CALIFORNIA ANESTHESIA INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/09/2010
-----------------------------------------------------
Last Update Date | 07/20/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15195 NATIONAL AVENUE SUITE 205
-----------------------------------------------------
City | LOS GATOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95032-2631
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-656-5522
-----------------------------------------------------
Fax | 408-872-4484
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15195 NATIONAL AVENUE SUITE 205
-----------------------------------------------------
City | LOS GATOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95032-2631
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-656-5522
-----------------------------------------------------
Fax | 408-872-4484
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MATTHEW COOK
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 408-656-5522
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | A68913
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------