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NPI Code Detail

MEDICARE: CALIFORNIA ANESTHESIA SPECIALIST AMC

MEDICARE: CALIFORNIA ANESTHESIA SPECIALIST AMC
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
1363A00000XPhysician Assistant
2363L00000XNurse Practitioner
3367500000XCertified Registered Nurse Anesthetist
4207L00000XAnesthesiology Physician

General Provider Information

NPI Number : 1588954358
Entity Type Code : Organization
Provider Name (Legal Business Name) : CALIFORNIA ANESTHESIA SPECIALIST AMC
Provider Business Mailing Address
First Line : 7700 W SUNRISE BLVD
Second Line :
City : PLANTATION
State : FL
Zip : 33322-4113
Country : US
Telephone Number : 833-922-1080
Fax Number :
Provider Business Practice Location Address
First Line : 28062 BAXTER RD
Second Line :
City : MURRIETA
State : CA
Zip : 92563-1401
Country : US
Telephone Number : 833-929-1080
Fax Number :
Authorized Official
Title or Position : MD
Name : KATHY KONDAS
Credential : MD
Telephone Number : 833-922-1080
Provider Enumeration Date : 04/14/2011
Last Update Date : 10/01/2020

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