MEDICARE: ANESTHESIA MEDICAL PROFESSIONALS, PC

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	174400000X	Specialist

General Provider Information

NPI Number	:	1801849500
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANESTHESIA MEDICAL PROFESSIONALS, PC

Provider Business Mailing Address
First Line	:	PO BOX 7640
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85374-0110
Country	:	US
Telephone Number	:	623-584-9985
Fax Number	:	623-584-9986

Provider Business Practice Location Address
First Line	:	19424 N RH JOHNSON BLVD
Second Line	:
City	:	SUN CITY WEST
State	:	AZ
Zip	:	85375-1409
Country	:	US
Telephone Number	:	623-584-9985
Fax Number	:	623-584-9986

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SANTIAGO LARDIZABAL
Credential	:	MD
Telephone Number	:	623-584-9985

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	08/22/2020

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