Provider Demographics
NPI:1881201432
Name:EDC ANESTHESIA NURSING PC
Entity Type:Organization
Organization Name:EDC ANESTHESIA NURSING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EVA
Authorized Official - Middle Name:D
Authorized Official - Last Name:CSILLAG
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:949-588-2190
Mailing Address - Street 1:5 HOLLAND
Mailing Address - Street 2:#101
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2568
Mailing Address - Country:US
Mailing Address - Phone:949-588-2190
Mailing Address - Fax:949-588-2199
Practice Address - Street 1:72301 COUNTRY CLUB DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-8007
Practice Address - Country:US
Practice Address - Phone:760-776-8100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty