MEDICARE: FOOTHILL ANESTHESIA, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	RN375160, NA1954	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	ZZZ64046Z	OTHER	CA	BLUE SHIELD OF CALIFORNIA

General Provider Information

NPI Number	:	1285695650
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOTHILL ANESTHESIA, INC

Provider Business Mailing Address
First Line	:	301 S FAIR OAKS AVE STE 301
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91105-2562
Country	:	US
Telephone Number	:	818-317-6909
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 S FAIR OAKS AVE STE 301
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91105-2562
Country	:	US
Telephone Number	:	818-317-6909
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. GREGORY SCOTT WRIGHT
Credential	:	CRNA
Telephone Number	:	818-317-6909

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	08/05/2021

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Directions to “FOOTHILL ANESTHESIA, INC ” Practice Location

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