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General NPI Number Information
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NPI Number | 1821040411
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Entity Type | Organization
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Legal Business Name | MADERA ANESTHESIA ASSOC MED GRP
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 12/04/2007
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Provider Practice Location Address
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Address Line | 1250 E ALMOND
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City | MADERA
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State | CA
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Zip | 93637
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Country | US
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Telephone | 559-675-5555
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7096
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City | STOCKTON
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State | CA
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Zip | 95267-0096
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Country | US
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Telephone | 209-956-7725
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Fax | 209-956-7733
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Authorized Official
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Title or Position | GRP PRESIDENT
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Name | MR. VICTOR YANEZ
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Credential |
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Telephone | 559-675-5555
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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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