Basic Information
| Provider Information | |||||||||
| NPI: | 1689381105 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SCQ ANESTHESIA A PROFESSIONAL NURSING CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 34120 | ||||||||
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| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895334120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7757475050 | ||||||||
| FaxNumber: | 7757475005 | ||||||||
| Practice Location | |||||||||
| Address1: | 18840 VENTURA BLVD # 100A | ||||||||
| Address2: | |||||||||
| City: | TARZANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913563301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183456126 | ||||||||
| FaxNumber: | 8183455061 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2022 | ||||||||
| LastUpdateDate: | 11/07/2022 | ||||||||
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| AuthorizedOfficialLastName: | OU | ||||||||
| AuthorizedOfficialFirstName: | TIMOTHY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7757475050 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CRNA | ||||||||
| NPICertificationDate: | 11/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.