Provider Demographics
NPI:1154019941
Name:DMD ANESTHESIA A PROFESSIONAL NURSING CORPORATION
Entity type:Organization
Organization Name:DMD ANESTHESIA A PROFESSIONAL NURSING CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:DALITZ
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:707-775-1465
Mailing Address - Street 1:416B MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-3306
Mailing Address - Country:US
Mailing Address - Phone:831-800-7887
Mailing Address - Fax:831-998-7155
Practice Address - Street 1:1081 LOS PALOS DR
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-3916
Practice Address - Country:US
Practice Address - Phone:831-771-1458
Practice Address - Fax:831-998-7155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty