Provider Demographics
NPI:1952030124
Name:AMERICAN AMBULATORY ANESTHESIA ASSOCIATES
Entity Type:Organization
Organization Name:AMERICAN AMBULATORY ANESTHESIA ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDESTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-784-4088
Mailing Address - Street 1:4500 BROCKTON AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-4006
Mailing Address - Country:US
Mailing Address - Phone:951-784-4088
Mailing Address - Fax:
Practice Address - Street 1:4500 BROCKTON AVE STE 105
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-4006
Practice Address - Country:US
Practice Address - Phone:951-784-4088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-05
Last Update Date:2022-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty