Provider Demographics
NPI:1134987019
Name:MARIPOSA ANESTHESIA SERVICES LLC
Entity type:Organization
Organization Name:MARIPOSA ANESTHESIA SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRNA
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:F
Authorized Official - Last Name:LAZCANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-677-5659
Mailing Address - Street 1:921 SHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044-2203
Mailing Address - Country:US
Mailing Address - Phone:800-444-6110
Mailing Address - Fax:224-255-5813
Practice Address - Street 1:11850 THOMAS MILL DR
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-4726
Practice Address - Country:US
Practice Address - Phone:800-444-6110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty