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General NPI Number Information
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NPI Number | 1568579803
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Entity Type | Organization
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Legal Business Name | JARCO ANESTHESIA SERVICES, INC
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Dates
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Enumeration Date | 08/24/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 11487 VIA CAPRI
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City | LOMA LINDA
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State | CA
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Zip | 92354-3853
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Country | US
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Telephone | 909-796-8354
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Fax | 909-796-8355
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Provider Business Mailing Address
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Address Line | PO BOX 2175
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City | UPLAND
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State | CA
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Zip | 91785-2175
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Country | US
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Telephone | 909-608-2035
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Fax | 909-608-1081
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Authorized Official
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Title or Position | PRESIDENT
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Name | JECONIAS DEMIAR
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Credential | CRNA
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Telephone | 888-926-3600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 160039
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License Number State | CA
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