Provider Demographics
NPI:1285695650
Name:FOOTHILL ANESTHESIA, INC
Entity type:Organization
Organization Name:FOOTHILL ANESTHESIA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:818-317-6909
Mailing Address - Street 1:301 S FAIR OAKS AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2562
Mailing Address - Country:US
Mailing Address - Phone:818-317-6909
Mailing Address - Fax:
Practice Address - Street 1:301 S FAIR OAKS AVE STE 301
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2562
Practice Address - Country:US
Practice Address - Phone:818-317-6909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN375160, NA1954367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN3751600Medicaid
CAZZZ64046ZOtherBLUE SHIELD OF CALIFORNIA
CAZZZ64046ZOtherBLUE SHIELD OF CALIFORNIA
CAFI633AMedicare PIN
CAP08419Medicare UPIN
CAW16627Medicare PIN
CAZZZ64046ZOtherBLUE SHIELD OF CALIFORNIA