=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942024393
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EQUANIMITY ANESTHESIA PROFESSIONAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/12/2024
-----------------------------------------------------
Last Update Date | 11/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11368 STONEMONT PT
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92131-4322
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-576-1196
-----------------------------------------------------
Fax | 775-747-5005
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 34120
-----------------------------------------------------
City | RENO
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89533-4120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-747-5050
-----------------------------------------------------
Fax | 775-747-5005
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DANNY LEE VALENTINE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 717-576-1196
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------