Basic Information
| Provider Information | |||||||||
| NPI: | 1184122053 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAN DIEGO ANESTHESIA CONSULTANTS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9659 DEER TRAIL DR | ||||||||
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| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921273465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6503804263 | ||||||||
| FaxNumber: | 6197521727 | ||||||||
| Practice Location | |||||||||
| Address1: | 3444 KEARNY VILLA RD | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921231959 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8582683566 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2018 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| AuthorizedOfficialLastName: | ORDUNO | ||||||||
| AuthorizedOfficialFirstName: | RAMON | ||||||||
| AuthorizedOfficialMiddleName: | REINALDO | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6503804263 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | MSN, CRNA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 3605 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.