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General NPI Number Information
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NPI Number | 1841439361
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Entity Type | Organization
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Legal Business Name | ANESTHESIA IAG SERVICES LT
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Dates
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Enumeration Date | 02/05/2009
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Last Update Date | 02/05/2009
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Provider Practice Location Address
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Address Line | 13332 CABANA WAY
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City | VICTORVILLE
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State | CA
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Zip | 92392-6364
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Country | US
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Telephone | 760-241-2179
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Fax |
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Provider Business Mailing Address
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Address Line | 13332 CABANA WAY
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City | VICTORVILLE
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State | CA
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Zip | 92392-6364
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Country | US
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Telephone | 760-241-2179
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. GAYLE LEE ULSHAFER
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Credential | CRNA
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Telephone | 760-241-2179
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367H00000X
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Taxonomy Name | Anesthesiologist Assistant
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License Number | RN299944 CRNA 604
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License Number State | CA
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