Provider Demographics
NPI:1568609683
Name:MARTHA PECK ANESTHESIA NURSING INC
Entity Type:Organization
Organization Name:MARTHA PECK ANESTHESIA NURSING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PECK
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:310-937-2780
Mailing Address - Street 1:1109 STANFORD AVE
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-4039
Mailing Address - Country:US
Mailing Address - Phone:310-937-2780
Mailing Address - Fax:310-937-2780
Practice Address - Street 1:850 S ATLANTIC BLVD
Practice Address - Street 2:STE 201
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-4730
Practice Address - Country:US
Practice Address - Phone:310-937-2780
Practice Address - Fax:310-937-2780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3222367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty