Provider Demographics
NPI:1154931921
Name:LA JOLLA ANESTHESIA SERVICES, APNC
Entity type:Organization
Organization Name:LA JOLLA ANESTHESIA SERVICES, APNC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEANN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:858-945-6138
Mailing Address - Street 1:2755 TOKALON ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-2236
Mailing Address - Country:US
Mailing Address - Phone:858-945-6138
Mailing Address - Fax:619-276-4216
Practice Address - Street 1:9850 GENESEE AVE STE 880
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1233
Practice Address - Country:US
Practice Address - Phone:858-404-9929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty