Provider Demographics
NPI:1902013170
Name:OB-GYN ANESTHESIA ASSOC.
Entity Type:Organization
Organization Name:OB-GYN ANESTHESIA ASSOC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAMALA
Authorized Official - Middle Name:R
Authorized Official - Last Name:RAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-621-0640
Mailing Address - Street 1:PO BOX 691786
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78269-1786
Mailing Address - Country:US
Mailing Address - Phone:210-621-0640
Mailing Address - Fax:210-621-2386
Practice Address - Street 1:234 SAN PEDRO AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-1103
Practice Address - Country:US
Practice Address - Phone:210-224-2424
Practice Address - Fax:210-224-2040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF8625207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0060NCOtherBLUE CROSS GROUP NUMBER