Provider Demographics
NPI:1689823387
Name:JAYCO ANESTHESIA SERVICE LLC
Entity Type:Organization
Organization Name:JAYCO ANESTHESIA SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JABARI
Authorized Official - Middle Name:
Authorized Official - Last Name:JAWANZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-921-8122
Mailing Address - Street 1:11999 SAN VICENTE BLVD STE 440
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-5042
Mailing Address - Country:US
Mailing Address - Phone:310-471-5852
Mailing Address - Fax:310-472-9582
Practice Address - Street 1:2325 ULMERTON RD
Practice Address - Street 2:STE. 27
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33762-2282
Practice Address - Country:US
Practice Address - Phone:727-592-0991
Practice Address - Fax:727-209-4606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty