Provider Demographics
NPI:1356979215
Name:JR ANESTHESIA INC
Entity type:Organization
Organization Name:JR ANESTHESIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:760-297-1284
Mailing Address - Street 1:8861 VILLA LA JOLLA DR # 12237
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1918
Mailing Address - Country:US
Mailing Address - Phone:760-297-1284
Mailing Address - Fax:
Practice Address - Street 1:2327 JOURNEY ST
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91915-2440
Practice Address - Country:US
Practice Address - Phone:619-823-1970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-27
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service