Provider Demographics
NPI:1912521881
Name:INNERPEACE ANESTHESIA
Entity Type:Organization
Organization Name:INNERPEACE ANESTHESIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:559-349-6653
Mailing Address - Street 1:5 HALLAND
Mailing Address - Street 2:#101
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2568
Mailing Address - Country:US
Mailing Address - Phone:949-588-2190
Mailing Address - Fax:949-588-2199
Practice Address - Street 1:10884 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:LAS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-4646
Practice Address - Country:US
Practice Address - Phone:855-818-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty