Provider Demographics
NPI:1588285266
Name:SEPULVEDA ANESTHESIA INC
Entity type:Organization
Organization Name:SEPULVEDA ANESTHESIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHSEREJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-273-4272
Mailing Address - Street 1:5651 SEPULVEDA BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-2954
Mailing Address - Country:US
Mailing Address - Phone:818-273-4272
Mailing Address - Fax:818-273-4278
Practice Address - Street 1:5651 SEPULVEDA BLVD STE 103
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91411-2954
Practice Address - Country:US
Practice Address - Phone:818-273-4272
Practice Address - Fax:818-273-4278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-04
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty