Provider Demographics
NPI:1124586490
Name:VALLEY ANESTHESIA AND ANCILLARY SERVICES, INC.,
Entity Type:Organization
Organization Name:VALLEY ANESTHESIA AND ANCILLARY SERVICES, INC.,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAFFEI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-501-2001
Mailing Address - Street 1:5435 BALBOA BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-1686
Mailing Address - Country:US
Mailing Address - Phone:818-990-2383
Mailing Address - Fax:818-322-3100
Practice Address - Street 1:5435 BALBOA BLVD STE 101
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-1686
Practice Address - Country:US
Practice Address - Phone:818-990-2383
Practice Address - Fax:818-322-3100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1120OtherANESTHESIA AND ANCILLARY
CAC4225772OtherANESTHESIA AND ANCILLARY