Basic Information
| Provider Information | |||||||||
| NPI: | 1356910053 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EL CAMINO ANESTHESIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 235019 | ||||||||
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| City: | MONTGOMERY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 361235019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002325703 | ||||||||
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| Practice Location | |||||||||
| Address1: | 815 POLLARD RD | ||||||||
| Address2: | |||||||||
| City: | LOS GATOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950321438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4083786131 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2021 | ||||||||
| LastUpdateDate: | 08/02/2021 | ||||||||
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| AuthorizedOfficialLastName: | XANTHOPOULOS | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6502426379 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 08/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.