Provider Demographics
NPI:1760970016
Name:NEW WAVE ANESTHESIA MANAGMENT LLC
Entity Type:Organization
Organization Name:NEW WAVE ANESTHESIA MANAGMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:BOGDAN
Authorized Official - Last Name:FRATILA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-288-2201
Mailing Address - Street 1:16170 JONES MALTSBERGER RD STE 106
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-3202
Mailing Address - Country:US
Mailing Address - Phone:361-288-2201
Mailing Address - Fax:210-399-2731
Practice Address - Street 1:16170 JONES MALTSBERGER RD STE 106
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-3202
Practice Address - Country:US
Practice Address - Phone:361-288-2201
Practice Address - Fax:210-210-8183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-23
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1467484691OtherNPI DR FRATILA