Basic Information
| Provider Information | |||||||||
| NPI: | 1588169791 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAN JUAN ANESTHESIA SERVICES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1400 25TH AVE E | ||||||||
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| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981123651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2067200806 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3260 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | JUNEAU | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077968900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2018 | ||||||||
| LastUpdateDate: | 06/12/2018 | ||||||||
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| AuthorizedOfficialLastName: | SAN JUAN | ||||||||
| AuthorizedOfficialFirstName: | VICTORIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 2067200806 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.