Provider Demographics
NPI:1801849500
Name:ANESTHESIA MEDICAL PROFESSIONALS, PC
Entity Type:Organization
Organization Name:ANESTHESIA MEDICAL PROFESSIONALS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANTIAGO
Authorized Official - Middle Name:
Authorized Official - Last Name:LARDIZABAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-584-9985
Mailing Address - Street 1:PO BOX 7640
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-0110
Mailing Address - Country:US
Mailing Address - Phone:623-584-9985
Mailing Address - Fax:623-584-9986
Practice Address - Street 1:19424 N RH JOHNSON BLVD
Practice Address - Street 2:
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-1409
Practice Address - Country:US
Practice Address - Phone:623-584-9985
Practice Address - Fax:623-584-9986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ70749Medicare ID - Type Unspecified