Provider Demographics
NPI:1649554106
Name:ESTRELLA ANESTHESIA LLC
Entity type:Organization
Organization Name:ESTRELLA ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHARRON
Authorized Official - Middle Name:S
Authorized Official - Last Name:BLAZIC
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA-MS
Authorized Official - Phone:623-512-0047
Mailing Address - Street 1:PO BOX 72090
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-1019
Mailing Address - Country:US
Mailing Address - Phone:480-361-7680
Mailing Address - Fax:480-361-7683
Practice Address - Street 1:12556 S 177TH LN
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-5772
Practice Address - Country:US
Practice Address - Phone:480-361-7680
Practice Address - Fax:480-361-7683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty