Provider Demographics
NPI:1932891678
Name:SUNSET ANESTHESIA GROUP, A PROFESSIONAL NURSING CORPORATION
Entity Type:Organization
Organization Name:SUNSET ANESTHESIA GROUP, A PROFESSIONAL NURSING CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:REVE
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BRANDER
Authorized Official - Suffix:
Authorized Official - Credentials:DNP/CRNA
Authorized Official - Phone:631-339-5015
Mailing Address - Street 1:4903 SANCOLA AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-4839
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13916 LA MAIDA ST
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-1907
Practice Address - Country:US
Practice Address - Phone:310-775-1596
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-22
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty