Provider Demographics
NPI:1396778924
Name:TULARE ANESTHESIA ASSOCIATES, INC.
Entity type:Organization
Organization Name:TULARE ANESTHESIA ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-905-3231
Mailing Address - Street 1:1187 N WILLOW AVE
Mailing Address - Street 2:STE 103, PMB#300
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-4411
Mailing Address - Country:US
Mailing Address - Phone:559-324-7300
Mailing Address - Fax:559-324-7350
Practice Address - Street 1:869 N CHERRY ST
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-2207
Practice Address - Country:US
Practice Address - Phone:559-688-0821
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37394207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0104690Medicaid
CA050036290OtherOTHER
CAGR0104690Medicaid