Provider Demographics
NPI:1619562006
Name:DESERT SUNRISE ANESTHESIA PLLC
Entity Type:Organization
Organization Name:DESERT SUNRISE ANESTHESIA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NEESANN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARIETTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-230-7805
Mailing Address - Street 1:6460 E GRANT RD # 32692
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-8800
Mailing Address - Country:US
Mailing Address - Phone:520-230-7805
Mailing Address - Fax:
Practice Address - Street 1:5301 E GRANT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2805
Practice Address - Country:US
Practice Address - Phone:520-230-7805
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-08
Last Update Date:2023-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ090595Medicaid