Provider Demographics
NPI:1356088512
Name:LAKES ANESTHESIA LLC
Entity Type:Organization
Organization Name:LAKES ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAMARYS
Authorized Official - Middle Name:
Authorized Official - Last Name:VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-403-2560
Mailing Address - Street 1:2100 W 76TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5505
Mailing Address - Country:US
Mailing Address - Phone:305-403-2560
Mailing Address - Fax:
Practice Address - Street 1:2100 W 76TH ST STE 101
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5505
Practice Address - Country:US
Practice Address - Phone:305-403-2560
Practice Address - Fax:786-439-2282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty