Provider Demographics
NPI:1457776833
Name:ANESTHESIA IAG SERVICES LTD
Entity type:Organization
Organization Name:ANESTHESIA IAG SERVICES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ULSHAFER
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:760-241-2179
Mailing Address - Street 1:13332 CABANA WAY
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-6364
Mailing Address - Country:US
Mailing Address - Phone:760-241-2179
Mailing Address - Fax:760-241-1950
Practice Address - Street 1:13332 CABANA WAY
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-6364
Practice Address - Country:US
Practice Address - Phone:760-241-2179
Practice Address - Fax:760-241-1950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-21
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACRNA 604282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital