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General NPI Number Information
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NPI Number | 1821186776
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Entity Type | Organization
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Legal Business Name | JP ANESTHESIOLOGY, INC
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 15447 W SAND ST
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City | VICTORVILLE
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State | CA
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Zip | 92392-2904
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Country | US
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Telephone | 760-843-9679
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Fax | 760-245-3618
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Provider Business Mailing Address
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Address Line | 15447 WEST SAND STREET
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City | VICTORVILLE
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State | CA
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Zip | 92392-4500
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Country | US
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Telephone | 760-843-9679
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Fax | 760-245-3618
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOE PARK
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Credential | M.D.
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Telephone | 760-843-9679
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | A86588
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License Number State | CA
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