MEDICARE: VICTORIA METRO ANESTHESIA

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
2	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1285882712
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VICTORIA METRO ANESTHESIA

Provider Business Mailing Address
First Line	:	6242 N NAVARRO ST
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77904-1705
Country	:	US
Telephone Number	:	361-575-4524
Fax Number	:	361-575-4534

Provider Business Practice Location Address
First Line	:	6242 N NAVARRO ST
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77904-1705
Country	:	US
Telephone Number	:	361-575-4524
Fax Number	:	361-575-4534

Authorized Official
Title or Position	:	OWNER
Name	:	ELIAS BENHAMOU
Credential	:
Telephone Number	:	361-575-4524

Provider Enumeration Date	:	09/09/2008
Last Update Date	:	09/09/2008

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Directions to “VICTORIA METRO ANESTHESIA ” Practice Location

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