Basic Information
| Provider Information | |||||||||
| NPI: | 1992908693 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HIGH DESERT ANESTHESIOLOGY,INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2019 | ||||||||
| Address2: | |||||||||
| City: | YUCCA VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922862019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603623777 | ||||||||
| FaxNumber: | 7602282151 | ||||||||
| Practice Location | |||||||||
| Address1: | 555 S 7TH AVE | ||||||||
| Address2: | |||||||||
| City: | BARSTOW | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923113043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7602561761 | ||||||||
| FaxNumber: | 7609573053 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2007 | ||||||||
| LastUpdateDate: | 04/03/2009 | ||||||||
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| AuthorizedOfficialLastName: | HARRISON | ||||||||
| AuthorizedOfficialFirstName: | KIM | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7603623777 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | C25869 | IN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.