Provider Demographics
NPI:1588831531
Name:SURGICAL ANESTHESIA SERVICES OF CALIFORNIA
Entity Type:Organization
Organization Name:SURGICAL ANESTHESIA SERVICES OF CALIFORNIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:R
Authorized Official - Last Name:RIBAUDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-217-2659
Mailing Address - Street 1:13523 BARRETT PARKWAY DRIVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-3802
Mailing Address - Country:US
Mailing Address - Phone:636-549-2404
Mailing Address - Fax:636-549-2392
Practice Address - Street 1:2120 COWELL BLVD.
Practice Address - Street 2:SUITE 142
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95618-7840
Practice Address - Country:US
Practice Address - Phone:530-750-7755
Practice Address - Fax:530-750-7767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAY937Medicare PIN