Basic Information
| Provider Information | |||||||||
| NPI: | 1447440326 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANESTHESIA MEDICAL PROFFESIONALS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19424 N R H JOHNSON BLVD | ||||||||
| Address2: | |||||||||
| City: | SUN CITY WEST | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853751409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235849985 | ||||||||
| FaxNumber: | 6235849986 | ||||||||
| Practice Location | |||||||||
| Address1: | 19424 N R H JOHNSON BLVD | ||||||||
| Address2: | |||||||||
| City: | SUN CITY WEST | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853751409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235849985 | ||||||||
| FaxNumber: | 6235849986 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2007 | ||||||||
| LastUpdateDate: | 07/27/2007 | ||||||||
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| AuthorizedOfficialLastName: | LARDIZABAL | ||||||||
| AuthorizedOfficialFirstName: | SANTIAGO | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6235849985 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | RN109068 | AZ | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.