Provider Demographics
NPI:1033419791
Name:MOONLIGHT ANESTHESIA, P.L.
Entity Type:Organization
Organization Name:MOONLIGHT ANESTHESIA, P.L.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-489-3166
Mailing Address - Street 1:PO BOX 07272
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-0272
Mailing Address - Country:US
Mailing Address - Phone:239-489-3166
Mailing Address - Fax:239-481-3650
Practice Address - Street 1:5238 MASON CORBIN CT
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-7738
Practice Address - Country:US
Practice Address - Phone:239-489-3166
Practice Address - Fax:239-481-3650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97767207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty