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General NPI Number Information
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NPI Number | 1649554106
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Entity Type | Organization
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Legal Business Name | ESTRELLA ANESTHESIA LLC
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Dates
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Enumeration Date | 10/03/2011
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Last Update Date | 10/03/2011
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Provider Practice Location Address
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Address Line | 12556 S 177TH LN
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City | GOODYEAR
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State | AZ
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Zip | 85338-5772
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Country | US
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Telephone | 480-361-7680
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Fax | 480-361-7683
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Provider Business Mailing Address
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Address Line | PO BOX 72090
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City | PHOENIX
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State | AZ
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Zip | 85050-1019
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Country | US
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Telephone | 480-361-7680
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Fax | 480-361-7683
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Authorized Official
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Title or Position | OWNER / PRESIDENT
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Name | SHARRON S BLAZIC
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Credential | CRNA-MS
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Telephone | 623-512-0047
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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 |
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License Number State | AZ
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