Basic Information
| Provider Information | |||||||||
| NPI: | 1851948103 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COASTAL ANESTHESIA MANAGEMENT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 34120 | ||||||||
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| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895334120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7757475050 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6501 TRUXTUN AVE STE 180 | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933090633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613222206 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2019 | ||||||||
| LastUpdateDate: | 08/21/2019 | ||||||||
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| AuthorizedOfficialLastName: | HILT | ||||||||
| AuthorizedOfficialFirstName: | GARRETT | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9518363128 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CRNA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.