Provider Demographics
NPI:1184122053
Name:SAN DIEGO ANESTHESIA CONSULTANTS
Entity type:Organization
Organization Name:SAN DIEGO ANESTHESIA CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:REINALDO
Authorized Official - Last Name:ORDUNO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MSN, CRNA
Authorized Official - Phone:650-380-4263
Mailing Address - Street 1:9659 DEER TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-3465
Mailing Address - Country:US
Mailing Address - Phone:650-380-4263
Mailing Address - Fax:619-752-1727
Practice Address - Street 1:3444 KEARNY VILLA RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1959
Practice Address - Country:US
Practice Address - Phone:858-268-3566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3605367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty